Latha Palaniappan, MD, MS

All Publications

• Implementation of Pharmacogenomic Consultations at a Rheumatology Clinic Spahn, C., Karapetian, N., Hong, J., Palaniappan, L. LIPPINCOTT WILLIAMS & WILKINS. 2025: 13-14

  View details for Web of Science ID 001351199700005

• Feasibility and Acceptability of Universal Adult Screening for Chronic Hepatitis B in Primary Care Clinics. AJPM focus Chu, R. V., Sarnala, S., Doan, T. V., Jamal, A., Phadke, A., So, S., So, R., Pham, H., Chaudhary, J., Huang, R., Kim, G., Palaniappan, L., Kim, K., Srinivasan, M. 2024; 3 (6): 100240

  Abstract

  Two thirds of Americans infected with chronic hepatitis B are unaware of their infection. In March 2023, the Centers for Disease Control and Prevention recommended moving from risk-based to universal adult chronic hepatitis B screening. In April 2022, Stanford implemented chronic hepatitis B universal screening discussion alerts for primary care providers.After 6 months, the authors surveyed 143 primary care providers at 13 Stanford primary care clinics about universal chronic hepatitis B screening acceptability and implementation feasibility. They conducted semistructured interviews with 15 primary care providers and 5 medical assistants around alerts and chronic hepatitis B universal versus risk-based screening.Forty-five percent of surveyed primary care providers responded. A total of 63% reported that universal screening would identify more patients with chronic hepatitis B. Before implementation, 77% ordered 0-5 chronic hepatitis B screenings per month. After implementation, 71% ordered >6 screenings per month. A total of 66% shared that universal screening removed the stigma around discussing high-risk behaviors. Interview themes included (1) low clinical burden, (2) current underscreening of at-risk groups, (3) providers preferring universal screening, (4) patients accepting universal screening, and (5) ease of chronic hepatitis B alert implementation.Consistent with Centers for Disease Control and Prevention guidelines, implementing universal chronic hepatitis B screening in primary care clinics in Northern California was feasible, was acceptable to providers and patients, eased health maintenance burdens, and improved clinic workflows.

  View details for DOI 10.1016/j.focus.2024.100240

  View details for PubMedID 39582739

  View details for PubMedCentralID PMC11584556

• Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia. Journal of medical Internet research Yi, S., Yam, E. L., Cheruvettolil, K., Linos, E., Gupta, A., Palaniappan, L., Rajeshuni, N., Vaska, K. G., Schulman, K., Eggleston, K. N. 2024; 26: e57612

  Abstract

  Digital health innovations have emerged globally as a transformative force for addressing health system challenges, particularly in resource-constrained settings. The COVID-19 pandemic underscored the critical importance of these innovations for enhancing public health. In South and Southeast Asia, a region known for its cultural diversity and complex health care landscape, digital health innovations present a dynamic interplay of challenges and opportunities. We advocate for ongoing research built into system development and an evidence-based strategy focusing on designing and scaling national digital health infrastructures combined with a vibrant ecosystem or "marketplace" of local experiments generating shared experience about what works in which settings. As the global digital health revolution unfolds, the perspectives drawn from South and Southeast Asia-including the importance of local partnerships-may provide valuable insights for shaping future strategies and informing similar initiatives in low- and middle-income countries, contributing to effective digital health strategies across diverse global health contexts.

  View details for DOI 10.2196/57612

  View details for PubMedID 39586089

• Navigating Polygenic Risk Scores in Primary Care: Challenges and Considerations for Diverse Populations. American family physician David, S. P., Palaniappan, L. 2024; 110 (5): 454-456

  View details for PubMedID 39556622

• Factors Associated with Lipoprotein(a) Testing Among Multiethnic Individuals. Journal of general internal medicine Brar, S., Huang, Q., Yan, X., Dudum, R., Jose, P., Sarraju, A., Palaniappan, L., Rodriguez, F. 2024

  Abstract

  Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and clinical guidelines recommend incorporating Lp(a) testing in routine care.Examine real-world, contemporary clinical testing patterns of Lp(a) among multiethnic populations.In this nested case-control study, we assessed the prevalence and factors associated with Lp(a) testing within a large Northern Californian health system between 2010 and 2021. Incident density matching was used to select controls matched with a case for a case:control ratio of up to 1:5. Conditional logistic regression was used to assess the relationship between Lp(a) testing, sociodemographic, and clinical characteristics.We included individuals aged 18 years or older with ≥ 2 primary care visits during the study period.Lp(a) testing rates over time and factors associated with testing based on demographic, medical, and healthcare utilization variables.Of the 1,484,410 individuals in the cohort, 14,818 (1.0%) underwent Lp(a) testing. The median Lp(a) level was 35 mg/dL and over a third of individuals had Lp(a) levels > 50 mg/dL. After adjustment, South Asian individuals were three times more likely to have undergone Lp(a) testing, as compared to non-Hispanic White individuals [OR = 3.19, (95% CI = 2.98, 3.41)], while those identified as non-Hispanic Black and Hispanic were significantly less likely to have undergone Lp(a) testing [OR = 0.70, (95% CI = 0.62, 0.80) and 0.64 (95% CI = 0.59, 0.69), respectively]. Those with a history of ASCVD had over twice the odds of undergoing testing [OR = 2.14 (95% CI = 1.99, 2.29)], as did individuals with more frequent primary care visits [OR = 1.99 (95% CI = 1.84, 2.15)].Lp(a) testing rates in real-world settings are low, with significant disparities by race, ethnicity, and healthcare utilization. Expanding access to Lp(a) testing may help reduce disparities within ASCVD risk assessment and treatment as new targeted therapeutic agents become available.

  View details for DOI 10.1007/s11606-024-09126-6

  View details for PubMedID 39455482

  View details for PubMedCentralID 10547299

• Neonatal mortality among disaggregated Asian American and Native Hawaiian/Pacific Islander populations. Journal of perinatology : official journal of the California Perinatal Association Maricar, I. N., Helkey, D., Nadarajah, S., Akiba, R., Bacong, A. M., Razdan, S., Palaniappan, L., Phibbs, C. S., Profit, J. 2024

  Abstract

  We compared neonatal (<28 days) mortality rates (NMRs) across disaggregated Asian American and Native Hawaiian/Pacific Islander (AANHPI) groups using recent, national data.We used 2015-2019 cohort-linked birth-infant death records from the National Vital Statistics System. Our sample included 61,703 neonatal deaths among 18,709,743 births across all racial and ethnic groups. We compared unadjusted NMRs across disaggregated AANHPI groups, then compared NMRs adjusting for maternal sociodemographic, maternal clinical, and neonatal risk factors.Unadjusted NMRs differed by over 3-fold amongst disaggregated AANHPI groups. Native Hawaiian/Pacific Islander neonates in aggregate had the highest fully-adjusted odds of mortality (OR: 1.08 [95% CI: 0.89, 1.31]) compared to non-Hispanic White neonates. Filipino, Asian Indian, and Other Asian neonates experienced significant decreases in odds ratios after adjusting for neonatal risk factors.Aggregating AANHPI neonates masks large heterogeneity and undermines opportunities to provide targeted care to higher-risk groups.

  View details for DOI 10.1038/s41372-024-02149-1

  View details for PubMedID 39397056

  View details for PubMedCentralID 6805610

• Cancer Mortality among Hispanic groups in the US, by birthplace (2003-2017). Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology He, Y., Pinheiro, P. S., Tripathi, O., Nguyen, H., Srinivasan, M., Palaniappan, L. P., Thompson, C. A. 2024

  Abstract

  BACKGROUND: The Hispanic population is the second largest racial/ethnic group in the US, consisting of multiple distinct ethnicities. Ethnicity-specific variations in cancer mortality may be attributed to countries of birth, so we aimed to understand differences in cancer mortality among disaggregated Hispanics by nativity (native- or foreign- born vs. US-born) over 15 years.METHODS: 228,197 Hispanic decedents (Mexican, Puerto Rican [PR], Cuban, and Central or South American) with cancer-related deaths from US death certificates (2003-2017) were analyzed. Seven cancers that contribute significantly to Hispanic male (lung and bronchus, colon and rectum, liver, prostate, and pancreas cancers) and female (lung and bronchus, liver, pancreas, colon and rectum, female breast, and ovary cancers) mortality were selected for analysis. 5-year age-adjusted mortality rates [AAMR (95% CI); per 100,000] and standardized mortality ratios [SMR (95% CI)] using foreign-born as the reference group were calculated. Joinpoint regression analysis was used to model cancer-related mortality trends.RESULTS: Puerto Rico-born PRs, Cuba-born Cubans, and US-born Mexicans had some of the highest cancer death rates among all the Hispanic groups. In general, foreign-born Hispanics had higher cancer mortality rates than US-born, except Mexicans. Overall, US-born and non-US-born (i.e. native- or foreign- born) Hispanic groups experienced decreasing rates of cancer deaths over the years.CONCLUSIONS: We noted vast heterogeneity in mortality rates by nativity across Hispanic groups, a fast-growing diverse US population.IMPACT: Understanding disaggregated patterns and trends in cancer burden can motivate deeper discussion around community health resources, which may improve the health of Hispanics across the US.

  View details for DOI 10.1158/1055-9965.EPI-24-0792

  View details for PubMedID 39361352

• Associations between accurate measures of adiposity and fitness, blood proteins, and insulin sensitivity among South Asians and Europeans. medRxiv : the preprint server for health sciences Kho, P. F., Stell, L., Jimenez, S., Zanetti, D., Panyard, D. J., Watson, K. L., Sarraju, A., Chen, M. L., Lind, L., Petrie, J. R., Chan, K. N., Fonda, H., Kent, K., Myers, J. N., Palaniappan, L., Abbasi, F., Assimes, T. L. 2024

  Abstract

  South Asians (SAs) may possess a unique predisposition to insulin resistance (IR). We explored this possibility by investigating the relationship between 'gold standard' measures of adiposity, fitness, selected proteomic biomarkers, and insulin sensitivity among a cohort of SAs and Europeans (EURs).A total of 46 SAs and 41 EURs completed 'conventional' (lifestyle questionnaires, standard physical exam) as well as 'gold standard' (dual energy X-ray absorptiometry scan, cardiopulmonary exercise test, and insulin suppression test) assessments of adiposity, fitness, and insulin sensitivity. In a subset of 28 SAs and 36 EURs, we also measured the blood-levels of eleven IR-related proteins. We conducted Spearman correlation to identify correlates of steady-state plasma glucose (SSPG) derived from the insulin suppression test, followed by multivariable linear regression analyses of SSPG, adjusting for age, sex and ancestral group.Sixteen of 30 measures significantly associated with SSPG, including one conventional and eight gold standard measures of adiposity, one conventional and one gold standard measure of fitness, and five proteins. Multivariable regressions revealed that gold standard measures and plasma proteins attenuated ancestral group differences in IR, suggesting their potential utility in assessing IR, especially among SAs.Ancestral group differences in IR may be explained by accurate measures of adiposity and fitness, with specific proteins possibly serving as useful surrogates for these measures, particularly for SAs.

  View details for DOI 10.1101/2024.09.06.24313199

  View details for PubMedID 39281745

  View details for PubMedCentralID PMC11398600

• Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY Li, J., Daida, Y. G., Bacong, A., Rosales, A., Frankland, T. B., Varga, A., Chung, S., Fortmann, S. P., Waitzfelder, B., Palaniappan, L. 2024; 19

  View details for DOI 10.1016/j.ajpc.2024.100688

  View details for Web of Science ID 001265185400001

• Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations. American journal of preventive cardiology Li, J., Daida, Y. G., Bacong, A. M., Rosales, A. G., Frankland, T. B., Varga, A., Chung, S., Fortmann, S. P., Waitzfelder, B., Palaniappan, L. 2024; 19: 100688

  Abstract

  Cardiovascular disease (CVD) is the leading cause of death in the United States, and rates of CVD incidence vary widely by race and ethnicity. Cigarette smoking is associated with increased risk of CVD. The purpose of the study was: 1) to examine smoking prevalence over time across Asian and Pacific Islander (API) and multi-race API subgroups; 2) to determine whether the CVD risk associated with smoking differed among these subgroups.We identified patients belonging to 7 single race/ethnicity groups, 4 multi-race/ethnicity groups, and a non-Hispanic White (NHW) comparison group at two large health systems in Hawaii and California. We estimated annual smoking prevalence from 2011 through 2018 by group and gender. We examined incidence of CVD events by smoking status and race/ethnicity, and computed hazard ratios for CVD events by age, gender, race/ethnicity, census block median household income, census block college degree, and study site using Cox regression.Of the 12 groups studied, the Asian Indian and Chinese American groups had the lowest smoking prevalence, and the Asian + Pacific Islander multiracial group had the highest smoking prevalence. The prevalence of smoking decreased from 2011 to 2018 for all groups. Multi-race/ethnicity groups had higher risk of CVD than the NHW group. There was no significant interaction between race/ethnicity and smoking in models predicting CVD, but the association between race/ethnicity and CVD incidence was attenuated after adjusting for smoking status.There is considerable heterogeneity in smoking prevalence and the risk of CVD among API subgroups.

  View details for DOI 10.1016/j.ajpc.2024.100688

  View details for PubMedID 39070025

  View details for PubMedCentralID PMC11278113

• Opioid overdose deaths are prominent in urban counties within the USA: an observational cross-sectional study. British journal of anaesthesia Patankar, A. V., Octaviano, R., Gurachar, N., Chen, A. W., Guan, A., Hung, G. A., Kikuta, N., Jamal, A., Srinivasan, M., Bacong, A. M., Huang, R. J., Kim, G. S., Palaniappan, L. P., Gross, E. R. 2024

  View details for DOI 10.1016/j.bja.2024.07.020

  View details for PubMedID 39209699

• Allergic disease prevalence among Asian American children in Northern California. The journal of allergy and clinical immunology. In practice Feng, C., Mudiganti, S., Yan, X. S., Mitchell, D., Chen, M., Liu, A. Y., Palaniappan, L., Arroyo, A. C. 2024

  View details for DOI 10.1016/j.jaip.2024.08.040

  View details for PubMedID 39197749

• Effects of a Triage Checklist to Optimize Insomnia Treatment Outcomes and Reduce Hypnotic Use: The RESTING Study. Sleep Manber, R., Gumport, N. B., Tully, I. A., Kim, J. P., Kim, B., Simpson, N., Rosas, L. G., Zulman, D. M., Goldhaber-Fiebert, J. D., Rangel, E., Dietch, J. R., Tutek, J., Palaniappan, L. 2024

  Abstract

  Evaluate a triaged stepped-care strategy among adults 50 and older with insomnia disorder.Participants (N=245) were classified at baseline by a Triage-Checklist. Those projected to do better if they start treatment with therapist versus digitally delivered CBT-I (tCBT-I versus dCBT-I) constituted the YES stratum (n=137); the rest constituted the NO stratum (n=108). Participants were randomized within stratum to a strategy that utilized only dCBT-I (ONLN) or to a strategy that prospectively allocated the first step of care to dCBT-I or tCBT-I based on the Triage-Checklist and switched dCBT-I non-responders at 2-months to tCBT-I (STEP). Co-primary outcomes were the insomnia severity index (ISI) and the average nightly amount of prescription hypnotic medications used (MEDS), assessed at 2,4,6,9, and 12 months post-randomization.Mixed effects models revealed that, compared to ONLN, participants in STEP had greater reductions in ISI (p=0.001; η2=0.01) and MEDS (p=0.019, η2=0.01). Within the YES stratum, compared to ONLN, those in STEP had greater reductions in ISI (p=0.0001, η2=0.023) and MEDS (p=0.018, η2=0.01). Within the ONLN arm, compared to the YES stratum, those in the NO stratum had greater reductions in ISI (p=0.015, η2=0.01) but not in MEDS. Results did not change with treatment-dose covariate adjustment.Triaged-stepped care can help guide allocation of limited CBT-I treatment resources to promote effective and safe treatment of chronic insomnia among middle age and older adults. Further refinement of the Triage-Checklist and optimization of the timing and switching criteria may improve the balance between effectiveness and use of resources.

  View details for DOI 10.1093/sleep/zsae182

  View details for PubMedID 39115347

• A global perspective on socioeconomic determinants of cardiovascular health. The Canadian journal of cardiology Wilder, B., Pinedo, A., Abusin, S., Ansell, D., Bacong, A. M., Calvin, J., Cha, S. W., Doukky, R., Hasan, F., Luo, S., Oktay, A. A., Palaniappan, L., Rana, N., Rivera, F. B., Fayaz, B., Suliman, A. A., Volgman, A. S. 2024

  Abstract

  Cardiovascular disease (CVD) is the leading cause of mortality in the world. From 2005 to 2008, the World Health Organization (WHO) planned an initiative to reduce the mortality rate of CVD by 2030 by addressing health, finance, transport, education, and agriculture in these communities. Plans were underway by many countries to meet the goals of the WHO initiative. However, in 2020, the COVID-19 pandemic derailed these goals, and many health systems suffered as the world battled the viral pandemic. The pandemic made health inequities even more prominent and necessitated a different approach to understanding and improving the socioeconomic determinants of health. The WHO initiated a special initiative to improve SDOH globally. This paper is an update on what other regions across the globe are doing to decrease, more specifically, the impact of socioeconomic determinants of cardiovascular health. Our review highlights how countries and regions like Canada, the United States, India, Southeast Asia, the Middle East, and Africa are uniquely impacted by various socioeconomic factors and how these countries are attempting to counter these obstacles by creating policies and protocols to facilitate an infrastructure that promotes screening and treatment of CVD. Ultimately, interventions directed towards populations that have been economically and socially marginalized may aid in reducing the disease and financial burden associated with CVD.

  View details for DOI 10.1016/j.cjca.2024.07.024

  View details for PubMedID 39095016

• Editorial: State of the science of pharmacogenomics implementation in healthcare systems and communities. Frontiers in pharmacology David, S. P., Devine, B., Palaniappan, L., Houwink, E. J. 2024; 15: 1463384

  View details for DOI 10.3389/fphar.2024.1463384

  View details for PubMedID 39114360

  View details for PubMedCentralID PMC11303329

• Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association CIRCULATION Joynt Maddox, K. E., Elkind, M. V., Aparicio, H. J., Commodore-Mensah, Y., de Ferranti, S. D., Dowd, W. N., Hernandez, A. F., Khavjou, O., Michos, E. D., Palaniappan, L., Penko, J., Poudel, R., Roger, V. L., Kazi, D. S., Amer Heart Assoc 2024; 150 (4): e65-e88

  Abstract

  Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial.Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics.We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic.The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.

  View details for DOI 10.1161/CIR.0000000000001256

  View details for Web of Science ID 001273906900002

  View details for PubMedID 38832505

• Nasopharyngeal cancer mortality in disaggregated Asian and non-Asian Americans. Head & neck Hung, G. A., Vohra, S., Kim, G., Jamal, A., Srinivasan, M., Huang, R. J., Kim, G., Palaniappan, L., Colevas, A. D. 2024

  Abstract

  Nasopharyngeal carcinoma (NPC) mortality varies based on multiple risk factors. While NPC mortality is higher in Asia, little is known about Asian subgroups in the United States (US).Using the 2005-2020 National Vital Statistics System, we examined NPC mortality by age, race (non-Hispanic black, Hispanic white (HW), non-Hispanic white (NHW), Chinese, Filipino, Asian Indian, Japanese, Korean, Vietnamese), sex, and nativity (Untied States or foreign-born).Upon disaggregation, Chinese (1.96 [CI: 1.78-2.16]), Filipino (0.68 [0.68-1.11]), and Vietnamese Americans (0.68 [0.52-1.10]) had the top age-adjusted mortality rates (AAMR per 100 000 person-years). Foreign-born Chinese, Vietnamese, Filipinos, Asian Indians, and NHW had higher AAMRs compared to US-born persons. All male groups had higher AAMR compared to females. Stratifying for race, nativity, and sex, foreign-born Chinese males (4.09 [3.79-4.40]) had the highest AAMR.These findings demonstrate the importance of disaggregating NPC mortality data by Asian subgroups, providing valuable insights for targeted public health interventions in the United States.

  View details for DOI 10.1002/hed.27857

  View details for PubMedID 39022914

• Working to Promote Health Equity: The Fourth Annual Disparities Issue. Circulation Carnethon, M. R., Palaniappan, L., Watson, K. 2024; 150 (3): 169-170

  View details for DOI 10.1161/CIRCULATIONAHA.124.070825

  View details for PubMedID 39008560

• Is strength training more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes? Reply to Pontes‑Silva A, Santos‑de‑Araujo AD, Teixeira BC et al [letter]. Diabetologia Kobayashi, Y., Long, J., Johannsen, N. M., Talamoa, R., Kent, K., Lamendola, C., Haddad, F., Church, T. S., Palaniappan, L. 2024

  View details for DOI 10.1007/s00125-024-06181-w

  View details for PubMedID 38888617

  View details for PubMedCentralID 10527535

• Relationship between body mass index and cardiometabolic health in a multi-ethnic population: A project baseline health study. American journal of preventive cardiology Shah, N. P., Lu, R., Haddad, F., Shore, S., Schaack, T., Mega, J., Pagidipati, N. J., Palaniappan, L., Mahaffey, K., Shah, S. H., Rodriguez, F. 2024; 18: 100646

  Abstract

  Obesity is associated with a higher risk of cardiovascular disease. Understanding the associations between comprehensive health parameters and body mass index (BMI) may lead to targeted prevention efforts.Project Baseline Health Study (PBHS) participants were divided into six BMI categories: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), class I obesity (30-34.9 kg/m2), class II obesity (35-39.9 kg/m2), and class III obesity (BMI ≥40 kg/m2). Demographic, cardiometabolic, mental health, and physical health parameters were compared across BMI categories, and multivariable logistic regression models were fit to evaluate associations.A total of 2,493 PBHS participants were evaluated. The mean age was 50±17.2 years; 55 % were female, 12 % Hispanic, 16 % Black, and 10 % Asian. The average BMI was 28.4 kg/m2±6.9. The distribution of BMI by age group was comparable to the 2017-2018 National Health and Nutrition Examination Survey (NHANES) dataset. The obesity categories had higher proportions of participants with CAC scores >0, hypertension, diabetes, lower HDL-C, lower vitamin D, higher triglycerides, higher hsCRP, lower mean step counts, higher mean PHQ-9 scores, and higher mean GAD-7 scores.We identified associations of cardiometabolic and mental health characteristics with BMI, thereby providing a deeper understanding of cardiovascular health across BMI.

  View details for DOI 10.1016/j.ajpc.2024.100646

  View details for PubMedID 38550633

  View details for PubMedCentralID PMC10966449

• Nasopharyngeal cancer mortality in disaggregated Asian and non-Asian Americans Hung, G. A., Vohra, S., Kim, G., Jamal, A., Srinivasan, M., Huang, R. J., Kim, G., Palaniappan, L., Colevas, A. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557404830

• Lipoprotein(a) Levels in Disaggregated Racial and Ethnic Subgroups Across Atherosclerotic Cardiovascular Disease Risk Levels. JACC. Advances Dudum, R., Huang, Q., Yan, X. S., Fonseca, M. A., Jose, P., Sarraju, A., Palaniappan, L., Rodriguez, F. 2024; 3 (6): 100940

  Abstract

  Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD).The authors assessed differences in Lp(a) testing and levels by disaggregated race, ethnicity, and ASCVD risk.This was a retrospective cohort study of patients from a large California health care system from 2010 to 2021. Eligible individuals were ≥18 years old, with ≥2 primary care visits, and complete race and ethnicity data who underwent Lp(a) testing. Race and ethnicity were self-reported and categorized as follows: non-Hispanic (NH) White, NH-Black, Hispanic (Mexican, Puerto Rican, other), NH-Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other). Logistic regression models tested associations between elevated Lp(a) (≥50 mg/dL) and race, ethnicity, and ASCVD risk.13,689 (0.9%) individuals underwent Lp(a) testing with a mean age of 54.6 ± 13.8 years, 49% female, 28.8% NH Asian. Over one-third of those tested had Lp(a) levels ≥50 mg/dL, ranging from 30.7% of Mexican patients to 62.6% of NH-Black patients. The ASCVD risk of those tested varied by race: 73.6% of Asian Indian individuals had <5% 10-year risk, whereas 27.2% of NH-Black had established ASCVD. Lp(a) prevalence ≥50 mg/dL increased across the ASCVD risk spectrum. After adjustment, Hispanic (OR: 0.76 [95% CI: 0.66-0.88]) and Asian (OR: 0.88 [95% CI: 0.81-0.96]) had lower odds of Lp(a) ≥50 mg/dL, whereas Black individuals had higher odds (OR: 2.46 [95% CI: 1.97-3.07]).Lp(a) testing is performed infrequently. Of those tested, Lp(a) levels were frequently elevated and differed significantly across disaggregated race and ethnicity groups. The prevalence of elevated Lp(a) increased with increasing ASCVD risk, with significant variation by race and ethnicity.

  View details for DOI 10.1016/j.jacadv.2024.100940

  View details for PubMedID 38938854

  View details for PubMedCentralID PMC11198068

• Leading causes of death in Vietnamese Americans: An ecological study based on national death records from 2005-2020. PloS one Tran, K., Shon, H., Phan, J., Cheng, T., Kim, G. S., Jamal, A., Srinivasan, M., Palaniappan, L. P., Nguyen, L., Huang, R. J. 2024; 19 (5): e0303195

  Abstract

  Disaggregated data is a cornerstone of precision health. Vietnamese Americans (VietAms) are the fourth-largest Asian subgroup in the United States (US), and demonstrate a unique burden of disease and mortality. However, most prior studies have aggregated VietAms under the broader Asian American category for analytic purposes. This study examined the leading causes of death among VietAms compared to aggregated Asian Americans and non-Hispanic Whites (NHWs) during the period 2005-2020.Decedent data, including underlying cause of death, were obtained from the National Center for Health Statistics national mortality file from 2005 to 2020. Population denominator estimates were obtained from the American Community Survey one-year population estimates. Outcome measures included proportional mortality, age-adjusted mortality rates per 100,000 (AMR), and annual percent change (APC) in mortality over time. Data were stratified by sex and nativity status. Due to large differences in age structure, we report native- and foreign-born VietAms separately.We identified 74,524 VietAm decedents over the study period (71,305 foreign-born, 3,219 native-born). Among foreign-born VietAms, the three leading causes of death were cancer (26.6%), heart disease (18.0%), and cerebrovascular disease (9.0%). Among native-born VietAms the three leading causes were accidents (19.0%), self-harm (12.0%), and cancer (10.4%). For every leading cause of death, VietAms exhibited lower mortality compared to both aggregated Asians and NHWs. Over the course of the study period, VietAms witnessed an increase in mortality in every leading cause. This effect was mostly driven by foreign-born, male VietAms.While VietAms have lower overall mortality from leading causes of death compared to aggregated Asians and NHWs, these advantages have eroded markedly between 2005 and 2020. These data emphasize the importance of racial disaggregation in the reporting of public health measures.

  View details for DOI 10.1371/journal.pone.0303195

  View details for PubMedID 38787829

• Increased COVID-19 mortality among immigrants compared with US-born individuals: a cross-sectional analysis of 2020 mortality data. Public health Bacong, A. M., Chu, R., Le, A., Bui, V., Wang, N. E., Palaniappan, L. P. 2024; 231: 173-178

  Abstract

  Multiple studies have shown that racially minoritized groups had disproportionate COVID-19 mortality relative to non-Hispanic White individuals. However, there is little known regarding mortality by immigrant status nationally in the United States, despite being another vulnerable population.This was an observational cross-sectional study using mortality vital statistics system data to calculate proportionate mortality ratios (PMRs) and mortality rates due to COVID-19 as the underlying cause.Rates were compared by decedents' identified race, ethnicity (Hispanic vs non-Hispanic), and immigrant (immigrants vs US born) status. Asian race was further disaggregated into "Asian Indian," "Chinese," "Filipino," "Japanese," "Korean," and "Vietnamese."Of the over 3.4 million people who died in 2020, 10.4% of all deaths were attributed to COVID-19 as the underlying cause (n = 351,530). More than double (18.9%, n = 81,815) the percentage of immigrants who died of COVID-19 compared with US-born decedents (9.1%, n = 269,715). PMRs due to COVID-19 were higher among immigrants compared with US-born individuals for non-Hispanic White, non-Hispanic Black, Hispanic, and most disaggregated Asian groups. Among disaggregated Asian immigrants, age- and sex-adjusted PMR due to COVID-19 ranged from 1.58 times greater mortality among Filipino immigrants (95% confidence interval [CI]: 1.53, 1.64) to 0.77 times greater mortality among Japanese immigrants (95% CI: 0.68, 0.86). Age-adjusted mortality rates were also higher among immigrant individuals compared with US-born people.Immigrant individuals experienced greater mortality due to COVID-19 compared with their US-born counterparts. As COVID-19 becomes more endemic, greater clinical and public health efforts are needed to reduce disparities in mortality among immigrants compared with their US-born counterparts.

  View details for DOI 10.1016/j.puhe.2024.03.016

  View details for PubMedID 38703491

• Correction to: Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial. Diabetologia Kobayashi, Y., Long, J., Dan, S., Johannsen, N. M., Talamoa, R., Raghuram, S., Chung, S., Kent, K., Basina, M., Lamendola, C., Haddad, F., Leonard, M. B., Church, T. S., Palaniappan, L. 2024

  View details for DOI 10.1007/s00125-024-06135-2

  View details for PubMedID 38689057

  View details for PubMedCentralID 2844943

• Chemerin Levels in Individuals with Type 2 Diabetes and a Normal Weight versus Individuals with Type 2 Diabetes and Obesity: An Observational, Cross-Sectional Study. Biomedicines Mukherji, A. B., Idowu, V., Zhao, L., Leung, L. L., Shen, S., Palaniappan, L., Morser, J. 2024; 12 (5)

  Abstract

  Chemerin acts as both a chemotactic agent and an adipokine that undergoes proteolytic cleavage, converting inactive precursors into their active forms before being subsequently inactivated. Elevated chemerin levels are linked to obesity and type 2 diabetes mellitus (T2D). This study aimed to elucidate the effects of T2D and obesity on chemerin levels by comparing plasma samples from individuals with a normal weight and T2D (BMI < 25; NWD group n = 22) with those from individuals who are overweight or obese and have T2D (BMI ≥ 25; OWD group n = 39). The total chemerin levels were similar in the NWD and OWD groups, suggesting that T2D may equalize the chemerin levels irrespective of obesity status. The cleavage of chemerin has been previously linked to myocardial infarction and stroke in NWD, with potential implications for inflammation and mortality. OWD plasma exhibited lower levels of cleaved chemerin than the NWD group, suggesting less inflammation in the OWD group. Here, we showed that the interaction between obesity and T2D leads to an equalization in the total chemerin levels. The cleaved chemerin levels and the associated inflammatory state, however, differ significantly, underscoring the complex relationship between chemerin, T2D, and obesity.

  View details for DOI 10.3390/biomedicines12050983

  View details for PubMedID 38790945

• Temporal Trends in Cardiovascular Disease Prevalence Among Asian American Subgroups. Journal of the American Heart Association Nguyen, K. T., Li, J., Peng, A. W., Azar, K., Heidenreich, P., Palaniappan, L., Yong, C. M. 2024: e031444

  Abstract

  Asian and multiracial individuals represent the 2 fastest growing racial and ethnic groups in the United States, yet most prior studies report Asian American and Native Hawaiian or Other Pacific Islander as a single racial group, with limited data on cardiovascular disease (CVD) prevalence among subgroups. We sought to evaluate temporal trends in CVD burden among disaggregated Asian subgroups.Patients with CVD based on International Classification of Diseases, Ninth Revision and Tenth Revision (ICD-9 and ICD-10) coding who received care from a mixed-payer health care organization in California between 2008 and 2018 were classified into self-identified racial and ethnic subgroups (non-Hispanic White [NHW], Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian or Other Pacific Islander, and multiracial groups). Adjusted trends in CVD prevalence over time by subgroup were compared using logistic regression. Among 3 494 071 patient-years, prevalence of CVD increased faster among all subgroups except Japanese and Native Hawaiian or Other Pacific Islander patients (P<0.01 for each, reference: NHW). Filipino patients had the highest overall CVD prevalence, which increased from 34.3% to 45.1% over 11 years (increase from 17.3%-21.9%, P<0.0001, reference: NHW). Asian Indian patients had the fastest increase in CVD prevalence over time (16.9%-23.7%, P<0.0001, reference: NHW). Among subcategories of disease, hypertension increased faster among Asian Indian, Chinese, Filipino, Korean, and multiracial groups (P<0.01 for all, reference: NHW), and coronary artery disease increased faster among Asian Indian, Chinese, Filipino, and Japanese groups (P<0.05 for each, reference: NHW).The increasing prevalence of CVD among disaggregated Asian, Native Hawaiian or Other Pacific Islander, and multiracial subgroups over time highlights the importance of tailored approaches to addressing CVD in these diverse subpopulations.

  View details for DOI 10.1161/JAHA.123.031444

  View details for PubMedID 38606778

• Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups. Journal of the American Heart Association Zhu, A. L., Le, A. D., Li, Y., Palaniappan, L. P., Srinivasan, M., Shah, N. S., Wong, S. S., Valero-Elizondo, J., Elfassy, T., Yang, E. 2024: e032509

  Abstract

  Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups.We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults.Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.

  View details for DOI 10.1161/JAHA.123.032509

  View details for PubMedID 38567660

• PEDSQL, EXERCISE CAPACITY, AND ENDOTHELIAL FUNCTION IN PEDIATRIC FONTAN PATIENTS Jose, J., Bernstein, D., Palaniappan, L. P., Leonard, M., Long, J., Desai, M., Lui, M., Davila, T., Cooke, J. P., Olson, I. L., Myers, J. N., Schneider, L., Tierney, E. ELSEVIER SCIENCE INC. 2024: 2407

  View details for Web of Science ID 001324901502441

• Obesity Disparities Among Adult Single-Race and Multiracial Asian and Pacific Islander Populations. JAMA network open Bacong, A. M., Gibbs, S. L., Rosales, A. G., Frankland, T. B., Li, J., Daida, Y. G., Fortmann, S. P., Palaniappan, L. 2024; 7 (3): e240734

  Abstract

  Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes.To examine disparities in the prevalence of obesity among single-race and multiracial Asian and Pacific Islander individuals compared with non-Hispanic White (hereafter, White) individuals.This cross-sectional study used electronic health record (EHR) data linked to social determinants of health and health behavior data for adult (age ≥18 years) members of 2 large health care systems in California and Hawai'i who had at least 1 ambulatory visit to a primary care practitioner between January 1, 2006, and December 31, 2018. Data were analyzed from October 31, 2022, to July 31, 2023.Self-identified race and ethnicity provided in the EHR as a single-race category (Asian Indian, Chinese, Filipino, Japanese, Native Hawaiian only, Other Pacific Islander, or White) or a multiracial category (Asian and Pacific Islander; Asian, Pacific Islander, and White; Asian and White; or Pacific Islander and White).The main outcome was obesity (body mass index [BMI] ≥30.0), based on last measured height and weight from the EHR. Logistic regression was used to examine the association between race and ethnicity and odds of obesity.A total of 5229 individuals (3055 [58.4%] male; mean [SD] age, 70.73 [11.51] years) were examined, of whom 444 (8.5%) were Asian Indian; 1091 (20.9%), Chinese; 483 (9.2%), Filipino; 666 (12.7%), Japanese; 91 (1.7%), Native Hawaiian; 95 (1.8%), Other Pacific Islander; and 888 (17.0%), White. The percentages of individuals who identified as multiracial were as follows: 417 (8.0%) were Asian and Pacific Islander; 392 (7.5%), Asian, Pacific Islander, and White; 248 (4.7%), Asian and White; and 414 (7.9%), Pacific Islander and White. A total of 1333 participants (25.5%) were classified as having obesity based on standard BMI criteria. Obesity was highest among people who identified as Asian, Pacific Islander, and White (204 of 392 [52.0%]) followed by those who identified as Other Pacific Islander (47 of 95 [49.5%]), Native Hawaiian (44 of 91 [48.4%]), and Pacific Islander and White (186 of 414 [44.9%]). After accounting for demographic, socioeconomic, and health behavior factors, people who identified as Asian, Pacific Islander, and White (odds ratio [OR], 1.80; 95% CI, 1.37-2.38) or Pacific Islander and White (OR, 1.55; 95% CI, 1.18-2.04) had increased odds of obesity compared with White individuals. All single-race Asian groups had lower odds of obesity compared with White individuals: Asian Indian (OR, 0.29; 95% CI, 0.20-0.40), Chinese (OR, 0.22; 95% CI, 0.17-0.29), Filipino (OR, 0.46; 95% CI, 0.35-0.62), and Japanese (OR, 0.38, 95% CI, 0.29-0.50).In this study, multiracial Asian and Pacific Islander individuals had an increased prevalence of obesity compared with many of their single-race counterparts. As the number of multiracial individuals increases, it will be important for clinical and public health systems to track disparities in these populations.

  View details for DOI 10.1001/jamanetworkopen.2024.0734

  View details for PubMedID 38502128

• Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity. American journal of preventive cardiology Sarraju, A., Yan, X., Huang, Q., Dudum, R., Palaniappan, L., Rodriguez, F. 2024; 17: 100647

  Abstract

  There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity.From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression.Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81-0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity.In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.

  View details for DOI 10.1016/j.ajpc.2024.100647

  View details for PubMedID 38525197

  View details for PubMedCentralID PMC10958062

• 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association CIRCULATION Martin, S. S., Aday, A. W., Almarzooq, Z. I., Anderson, C. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Gibbs, B., Beaton, A. Z., Boehme, A. K., Commodore-Mensah, Y., Currie, M. E., Elkind, M. V., Evenson, K. R., Generoso, G., Heard, D. G., Hiremath, S., Johansen, M. C., Kalani, R., Kazi, D. S., Ko, D., Liu, J., Magnani, J. W., Michos, E. D., Mussolino, M. E., Navaneethan, S. D., Parikh, N. I., Perman, S. M., Poudel, R., Rezk-Hanna, M., Roth, G. A., Shah, N. S., St-Onge, M., Thacker, E. L., Tsao, C. W., Urbut, S. M., Van Spall, H. C., Voeks, J. H., Wang, N., Wong, N. D., Wong, S. S., Yaffe, K., Palaniappan, L. P., Amer Heart Assoc Council Epidemiol Prevent Stat Comm Stroke Stat Subcomm 2024; 149 (8): E347-E913

  Abstract

  The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

  View details for DOI 10.1161/CIR.0000000000001209

  View details for Web of Science ID 001290797400001

  View details for PubMedID 38264914

• Prevalence of allergic diseases among Asian American children in a Northern California healthcare system Feng, C., Mudiganti, S., Yan, X., Mitchell, D., Chen, M., Liu, A., Palaniappan, L., Arroyo, A. MOSBY-ELSEVIER. 2024: AB250

  View details for Web of Science ID 001267526000772

• Risk of Gastric Adenocarcinoma in a Multiethnic Population undergoing Routine Care: an Electronic Health Records Cohort Study. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Huang, R. J., Huang, E. S., Mudiganti, S., Chen, T., Martinez, M. C., Ramrakhiani, S., Han, S. S., Hwang, J. H., Palaniappan, L. P., Liang, S. Y. 2024

  Abstract

  Gastric adenocarcinoma (GAC) is often diagnosed at advanced stages and portends a poor prognosis. We hypothesized that electronic health records (EHR) could be leveraged to identify individuals at highest risk for GAC from the population seeking routine care.This was a retrospective cohort study, with endpoint of GAC incidence as ascertained through linkage to an institutional tumor registry. We utilized 2010-2020 data from the Palo Alto Medical Foundation, a large multispecialty practice serving Northern California. The analytic cohort comprised individuals aged 40-75 receiving regular ambulatory care. Variables collected included demographic, medical, pharmaceutical, social, and familial data. Electronic phenotyping was based on rules-based methods.The cohort comprised 316,044 individuals and ~2 million person-years (p-y) of observation. 157 incident GACs occurred (incidence 7.9 per 100,000 p-y), of which 102 were non-cardia GACs (incidence 5.1 per 100,000 p-y). In multivariable analysis, male sex (HR 2.2, 95% CI 1.6-3.1), older age, Asian race (HR 2.5, 95% CI 1.7-3.7), Hispanic ethnicity (HR 1.9, 95% CI 1.1-3.3), atrophic gastritis (HR 4.6, 95% CI 2.2-9.3), and anemia (HR 1.9, 95% CI 1.3-2.6) were associated with GAC risk; use of non-steroidal anti-inflammatory drug was inversely associated (HR 0.3, 95% CI 0.2-0.5). Older age, Asian race, Hispanic ethnicity, atrophic gastritis, and anemia were associated with non-cardia GAC.Routine EHR data can stratify the general population for GAC risk.Such methods may help triage populations for targeted screening efforts, such as upper endoscopy.

  View details for DOI 10.1158/1055-9965.EPI-23-1200

  View details for PubMedID 38231023

• EFFECTIVENESS OF A NOVEL SCHOOL-BASED DIABETES PREVENTION PROGRAM: A POST-IMPLEMENTATION ANALYSIS OF AROGYA WORLD HEALTHY SCHOOL PROGRAM, INDIA 2015-2022 Rajeshuni, N., Huynh, M., Mahajan, S., Bacong, A., Mukherji, A., Jaswal, N., Ramalingam, S., Ganesh, N., Pahwa, S., Saligram, N., Palaniappan, L. SAGE PUBLICATIONS LTD. 2024: 461-462

  View details for Web of Science ID 001307337600475

• Associations Between Ultra-processed Food Consumption and Cardiometabolic Health Among Older US Adults: Comparing Older Asian Americans to Older Adults From Other Major Race-Ethnic Groups. Research on aging Elfassy, T., Juul, F., Mesa, R. A., Palaniappan, L., Srinivasan, M., Yi, S. S. 2023: 1640275231222928

  Abstract

  Using data from the National Health and Nutrition Examination Survey (2001-2018; N = 19,602), this study examined whether ultra-processed food (UPF) consumption is associated with cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes), among White, Black, Hispanic, and Asian Americans (AA) US adults 50 or older. Diet was assessed using 24 hour dietary recall. NOVA dietary classification system was used to calculate the percentage of caloric intake derived from UPFs. Cardiometabolic information was assessed through physical examination, blood tests, and self-reported medication information. A median of 54% (IQR: 40%, 68%) of caloric intake was attributed to UPFs and was lowest for AAs (34%, IQR: 20%, 49%) and highest for White adults (56%; IQR: 42, 69%). In multivariable adjusted models, UPF consumption was associated with greater odds of obesity, high cholesterol, and diabetes. UPF consumption is associated with poor cardiometabolic health among all US older adults. For AAs, UPFs may be particularly obesogenic.

  View details for DOI 10.1177/01640275231222928

  View details for PubMedID 38128550

• Opportunities to Increase Science of Diversity and Inclusion in Clinical Trials: Equity and a Lack of a Control. Journal of the American Heart Association Igwe, J., Wangdak Yuthok, T. Y., Cruz, E., Mueller, A., Lan, R. H., Brown-Johnson, C., Idris, M., Rodriguez, F., Clark, K., Palaniappan, L., Echols, M., Wang, P., Onwuanyi, A., Pemu, P., Lewis, E. F. 2023: e030042

  Abstract

  The United States witnessed a nearly 4-fold increase in personal health care expenditures between 1980 and 2010. Despite innovations and obvious benefits to health, participants enrolled in clinical trials still do not accurately represent the racial and ethnic composition of patients nationally or globally. This lack of diversity in cohorts limits the generalizability and significance of results among all populations and has deep repercussions for patient equity. To advance diversity in clinical trials, robust evidence for the most effective strategies for recruitment of diverse participants is needed. A major limitation of previous literature on clinical trial diversity is the lack of control or comparator groups for different strategies. To date, interventions have focused primarily on (1) community-based interventions, (2) institutional practices, and (3) digital health systems. This review article outlines prior intervention strategies across these 3 categories and considers health policy and ethical incentives for substantiation before US Food and Drug Administration approval. There are no current studies that comprehensively compare these interventions against one another. The American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials represents a multicenter, collaborative network between Stanford School of Medicine and Morehouse School of Medicine created to understand the barriers to diversity in clinical trials by contemporaneous head-to-head interventional strategies accessing digital, institutional, and community-based recruitment strategies to produce informed recruitment strategies targeted to improve underrepresented patient representation in clinical trials.

  View details for DOI 10.1161/JAHA.123.030042

  View details for PubMedID 38108253

• Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association CIRCULATION Khan, S. S., Coresh, J., Pencina, M. J., Ndumele, C. E., Rangaswami, J., Chow, S. L., Palaniappan, L. P., Sperling, L. S., Virani, S. S., Ho, J. E., Neeland, I. J., Tuttle, K. R., Singh, R., Elkind, M. V., Lloyd-Jones, D. M., Amer Heart Assoc 2023; 148 (24): 1982-2004

  Abstract

  Cardiovascular-kidney-metabolic (CKM) syndrome is a novel construct recently defined by the American Heart Association in response to the high prevalence of metabolic and kidney disease. Epidemiological data demonstrate higher absolute risk of both atherosclerotic cardiovascular disease (CVD) and heart failure as an individual progresses from CKM stage 0 to stage 3, but optimal strategies for risk assessment need to be refined. Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. Given the growing number of therapies in our armamentarium that simultaneously address all 3 CKM axes, novel risk prediction equations are needed that incorporate predictors and outcomes relevant to the CKM context. This should also include social determinants of health, which are key upstream drivers of CVD, to more equitably estimate and address risk. This scientific statement summarizes the background, rationale, and clinical implications for the newly developed sex-specific, race-free risk equations: PREVENT (AHA Predicting Risk of CVD Events). The PREVENT equations enable 10- and 30-year risk estimates for total CVD (composite of atherosclerotic CVD and heart failure), include estimated glomerular filtration rate as a predictor, and adjust for competing risk of non-CVD death among adults 30 to 79 years of age. Additional models accommodate enhanced predictive utility with the addition of CKM factors when clinically indicated for measurement (urine albumin-to-creatinine ratio and hemoglobin A1c) or social determinants of health (social deprivation index) when available. Approaches to implement risk-based prevention using PREVENT across various settings are discussed.

  View details for DOI 10.1161/CIR.0000000000001191

  View details for Web of Science ID 001121695100002

  View details for PubMedID 37947094

• Statistical Methods to Evaluate Surrogate Markers. Medical care Parast, L., Tian, L., Cai, T., Palaniappan, L. 2023

  Abstract

  There is tremendous interest in evaluating surrogate markers given their potential to decrease study time, costs, and patient burden.The purpose of this statistical workshop article is to describe and illustrate how to evaluate a surrogate marker of interest using the proportion of treatment effect (PTE) explained as a measure of the quality of the surrogate marker for (1) a setting with a general fully observed primary outcome (eg, biopsy score) and (2) a setting with a time-to-event primary outcome which may be censored due to study termination or early drop out (eg, time to diabetes).The methods are motivated by 2 randomized trials, one among children with nonalcoholic fatty liver disease where the primary outcome was a change in biopsy score (general outcome) and another study among adults at high risk for Type 2 diabetes where the primary outcome was time to diabetes (time-to-event outcome). The methods are illustrated using the Rsurrogate package with a detailed R code provided.In the biopsy score outcome setting, the estimated PTE of the examined surrogate marker was 0.182 (95% confidence interval [CI]: 0.121, 0.240), that is, the surrogate explained only 18.2% of the treatment effect on the biopsy score. In the diabetes setting, the estimated PTE of the surrogate marker was 0.596 (95% CI: 0.404, 0.760), that is, the surrogate explained 59.6% of the treatment effect on diabetes incidence.This statistical workshop provides tools that will support future researchers in the evaluation of surrogate markers.

  View details for DOI 10.1097/MLR.0000000000001956

  View details for PubMedID 38079232

• COVID-19 pandemic impact on opioid overdose deaths among racial groups within the United States: an observational cross-sectional study. British journal of anaesthesia Chu, R., Sarnala, S., Doan, T., Cheng, T., Chen, A. W., Jamal, A., Kim, G., Huang, R., Srinivasan, M., Palaniappan, L., Gross, E. R. 2023

  View details for DOI 10.1016/j.bja.2023.10.024

  View details for PubMedID 37977954

• Who Are We Missing? Reporting of Transgender and Gender-Expansive Populations in Clinical Trials. Journal of the American Heart Association Rice, E. N., Lan, R. H., Nunes, J. C., Shah, R., Clark, K., Periyakoil, V. S., Chen, J. H., Lin, B., Echols, M., Awad, C., Idris, M. Y., Cruz, E. R., Poullos, P. D., Lewis, E. F., Brown-Johnson, C., Igwe, J., Shen, S., Palaniappan, L., Stefanick, M. L., Ritter, V., Pemu, P., Rodriguez, F., Deb, B., Pundi, K., Wang, P. J. 2023: e030209

  View details for DOI 10.1161/JAHA.123.030209

  View details for PubMedID 37947088

• Development and Validation of the American Heart Association Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) Equations. Circulation Khan, S. S., Matsushita, K., Sang, Y., Ballew, S. H., Grams, M. E., Surapaneni, A., Blaha, M. J., Carson, A. P., Chang, A. R., Ciemins, E., Go, A. S., Gutierrez, O. M., Hwang, S. J., Jassal, S. K., Kovesdy, C. P., Lloyd-Jones, D. M., Shlipak, M. G., Palaniappan, L. P., Sperling, L., Virani, S. S., Tuttle, K., Neeland, I. J., Chow, S. L., Rangaswami, J., Pencina, M. J., Ndumele, C. E., Coresh, J. 2023

  Abstract

  Background: Multivariable equations are recommended by primary prevention guidelines to assess absolute risk of cardiovascular disease (CVD). However, current equations have several limitations. Therefore, we developed and validated the AHA Predicting Risk of CVD EVENTs (PREVENT) equations among US adults aged 30-79 years without known CVD. Methods: The derivation sample included individual-level participant data from 25 datasets (N=3,281,919) between 1992-2017. The primary outcome was CVD (atherosclerotic CVD [ASCVD] and heart failure [HF]). Predictors included traditional risk factors (smoking status, systolic blood pressure, cholesterol, anti-hypertensive or statin use, diabetes) and estimated glomerular filtration rate [eGFR]. Models were sex-specific, race-free, developed on the age-scale, and adjusted for competing risk of non-CVD death. Analyses were conducted in each dataset and meta-analyzed. Discrimination was assessed using Harrell's C-statistic. Calibration was calculated as the slope of the observed vs. predicted risk by decile. Additional equations to predict each CVD subtype (ASCVD, HF) and include optional predictors (urine albumin-to-creatinine ratio [UACR], hemoglobin A1c [HbA1c]), and social deprivation index [SDI]) were also developed. External validation was performed in 3,330,085 participants from 21 additional datasets. Results: Among 6,612,004 adults included, mean (SD) age was 53 (12) years and 56% were female. Over a mean (SD) follow-up of 4.8 (3.1) years, there were 211,515 incident total CVD events. The median C-statistics in external validation for CVD were 0.794 (interquartile interval [IQI]: 0.763-0.809) in female and 0.757 (0.727-0.778) in male participants. The calibration slopes were 1.03 (IQI 0.81 -1.16) and 0.94 (0.81-1.13) among females and males, respectively. Similar estimates for discrimination and calibration were observed for ASCVD- and HF-specific models. The improvement in discrimination was small but statistically significant when UACR, HbA1c, and SDI were added together to the base model to total CVD (ΔC-statistic [IQI] 0.004 [0.004, 0.005] and 0.005 [0.004, 0.007] among females and males, respectively). Calibration improved significantly when UACR was added to the base model among those with marked albuminuria (>300mg/g) (1.05 [0.84-1.20] vs. 1.39 [1.14-1.65], p=0.01). Conclusions: PREVENT equations accurately and precisely predicted risk for incident CVD and CVD subtypes in a large, diverse, and contemporary sample of US adults using routinely available clinical variables.

  View details for DOI 10.1161/CIRCULATIONAHA.123.067626

  View details for PubMedID 37947085

• Asthma heterogeneity amongst Asian American children: the California Health Interview Survey. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Chen, M., Bacong, A. M., Feng, C., Kikuta, N. T., Datir, R. R., Chen, S., Srinivasan, M., Camargo, C. A., Palaniappan, L., Arroyo, A. C. 2023

  Abstract

  The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden amongst AsA ethnic groups. The relation of obesity and asthma among AsA ethnic groups also remains unclear.To evaluate asthma prevalence and the relation of obesity to asthma risk amongst children in seven AsA ethnic groups.We analyzed data from the California Health Interview Survey from 2011-2020. AsA ethnicities were self-reported. Body mass index (BMI) z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on BMI-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months were calculated. We performed multivariable logistic regressions adjusting for age and sex.Of 34,146 survey respondents, 12.2% Non-Hispanic White (NHW) and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Compared to NHW children, AsA children had a similar lifetime asthma prevalence (aOR=1.05; 95%CI: 0.71-1.55; p=0.81), but lower prevalence in Korean American children (aOR 0.37; 95%CI, 0.19-0.73; p=0.004) and higher prevalence in Filipino American children (aOR 1.97; 95%CI, 1.22-3.17; p=0.006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status.Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence among Korean American children and highest prevalence among Filipino American. Further characterization of asthma burden amongst AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.

  View details for DOI 10.1016/j.anai.2023.10.030

  View details for PubMedID 37949352

• The association between local area immigrant fraction and prevalence of cardiovascular diseases in the United States: an observational study. Lancet regional health. Americas Shokeen, D., Wang, N., Nguyen, N. P., Bakal, E., Tripathi, O., Palaniappan, L. P., Huang, R. J. 2023; 27: 100613

  Abstract

  Local area immigrant fraction is strongly and positively correlated with local life expectancy in the United States. The aim of the study was to determine the relationship between local area immigrant fraction and local prevalence of coronary heart disease (CHD) and stroke.Cross-sectional study design, with ZIP code as the unit of observation. Demographic data was obtained from the American Community Survey, and linked to indicators of health access (e.g., insurance, annual check-ups, cholesterol screening), obesity, behavior (smoking, exercise), and cardiovascular outcomes data from the 2020 Population Level Analysis and Community Estimates. Multivariable regression and path analyses were used to assess both direct and indirect relationships among variables.CHD prevalence was lower in the second (3.9% relative difference, 95% CI: 3.1-4.5%), third (6.5%, 95% CI: 5.8-7.1%), and fourth (14.8%, 95% CI: 14.1-15.8%) quartiles of immigrant fraction compared to the lowest (p-trend <0.001). These effects remained robust in multivariable analysis following adjustment for indicators of access, obesity, and behavioral variables (p-trend <0.0001). For stroke, only the highest quartile demonstrated a significant difference in prevalence (2.1%, 95% CI: 1.2-3.0% with full adjustment). In CHD path analysis, ∼45% of the association of immigrant fraction was direct, and ∼55% was mediated through lower prevalence of deleterious behaviors (e.g., smoking). In stroke path analysis, the effect was entirely mediated through indirect effects.In the United States, ZIP codes with higher immigrant fractions have lower prevalence of cardiovascular diseases. These associations are partially mediated through differences in health behaviors at the community level.NIH (K08CA252635, P30AG0059304, K24HL150476), Stanford University, Rutgers University.

  View details for DOI 10.1016/j.lana.2023.100613

  View details for PubMedID 37860751

  View details for PubMedCentralID PMC10582736

• Risk of Incident Asthma among Young Asian American, Native Hawaiian, and Pacific Islander Children from Age 3 to 7 years in a Northern California Healthcare System. The Journal of pediatrics Arroyo, A. C., Ko, J., Chandra, M., Huang, P., Darbinian, J. A., Palaniappan, L., Lo, J. C. 2023: 113802

  Abstract

  Incident childhood asthma risk has not been examined among diverse Asian American, Native Hawaiian, and Pacific Islander subgroups. In a large California healthcare system, incident asthma was higher among young Filipino/a, Native Hawaiian/Pacific Islander, and South Asian children compared with Non-Hispanic White children, whereas Chinese and Japanese children were similar.

  View details for DOI 10.1016/j.jpeds.2023.113802

  View details for PubMedID 37898424

• Association of diabetes with coronary artery calcium in South Asian adults and other race/ethnic groups: The multi-ethnic study of atherosclerosis and the mediators of atherosclerosis in South Asians living in America study. Diabetes & vascular disease research Premyodhin, N., Fan, W., Arora, M., Budoff, M. J., Kanaya, A. M., Kandula, N., Palaniappan, L., Rana, J. S., Younus, M., Wong, N. D. 2023; 20 (5): 14791641231204368

  Abstract

  South Asian (SA) persons have increased risks for diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD). We examined whether the association of DM with subclinical atherosclerosis assessed by coronary artery calcium (CAC) differs in SA versus other ethnic groups.We studied adults from the Multi-Ethnic Study of Atherosclerosis and the Mediators of Atherosclerosis in South Asians Living in America studies without ASCVD. CAC was examined among those normoglycemic, pre-DM and DM. Logistic regression examined pre-DM and DM with the odds of any CAC > 0 and CAC ≥ 100.Among 7562 participants, CAC > 0 and CAC ≥ 100 in those with DM was highest in non-Hispanic White (NHW) (80% and 48%) and SA (72% and 41%) persons. Adjusted Ln (CAC + 1) was highest in NHW (3.68 ± 0.21) and SA (3.60 ± 0.23) (p < .01) DM patients. SA and NHW adults with DM (vs normoglycemic) had highest odds of CAC > 0 (2.13 and 2.27, respectively, p < .01). For CAC ≥ 100, SA and Chinese adults had the highest odds (2.28 and 2.27, respectively, p < .01). Fasting glucose and glycated hemoglobin were most strongly associated with CAC among SA.Diabetes mellitus most strongly relates to any CAC in SA and NHW adults and CAC ≥ 100 in SA and Chinese adults, helping to explain the relation of DM with ASCVD in these populations.

  View details for DOI 10.1177/14791641231204368

  View details for PubMedID 37795703

• Can earlier biomarker measurements explain a treatment effect on diabetes incidence? A robust comparison of five surrogate markers. BMJ open diabetes research & care Parast, L., Tian, L., Cai, T., Palaniappan, L. P. 2023; 11 (5)

  Abstract

  We measured and compared five individual surrogate markers-change from baseline to 1 year after randomization in hemoglobin A1c (HbA1c), fasting glucose, 2-hour postchallenge glucose, triglyceride-glucose index (TyG) index, and homeostatic model assessment of insulin resistance (HOMA-IR)-in terms of their ability to explain a treatment effect on reducing the risk of type 2 diabetes mellitus at 2, 3, and 4 years after treatment initiation.Study participants were from the Diabetes Prevention Program study, randomly assigned to either a lifestyle intervention (n=1023) or placebo (n=1030). The surrogate markers were measured at baseline and 1 year, and diabetes incidence was examined at 2, 3, and 4 years postrandomization. Surrogacy was evaluated using a robust model-free estimate of the proportion of treatment effect explained (PTE) by the surrogate marker.Across all time points, change in fasting glucose and HOMA-IR explained higher proportions of the treatment effect than 2-hour glucose, TyG index, or HbA1c. For example, at 2 years, glucose explained the highest (80.1%) proportion of the treatment effect, followed by HOMA-IR (77.7%), 2-hour glucose (76.2%), and HbA1c (74.6%); the TyG index explained the smallest (70.3%) proportion.These data suggest that, of the five examined surrogate markers, glucose and HOMA-IR were the superior surrogate markers in terms of PTE, compared with 2-hour glucose, HbA1c, and TyG index.

  View details for DOI 10.1136/bmjdrc-2023-003585

  View details for PubMedID 37907279

• Epicardial fat and Stage B heart failure among overweight/obese and normal weight individuals with diabetes mellitus. The international journal of cardiovascular imaging Kobayashi, Y., Nishi, T., Christle, J. W., Cauwenberghs, N., Kuznetsova, T., Palaniappan, L., Haddad, F. 2023

  Abstract

  Although up to 20% of people with type 2 diabetes (DM) have normal BMI (< 25 kg/m2), it remains unclear whether there is a difference in the development of cardiac dysfunction between those with normal and higher BMI. Furthermore, little is known about the relationship of visceral fat with BMI or fitness in asymptomatic patients with DM.We prospectively enrolled asymptomatic patients with DM and divided into two groups: BMI ≥ 25kg/m2 (overweight/obese group) versus < 25kg/m2(normal-weight group). Resting echocardiogram followed by exercise stress echocardiogram and exercise gas exchange analysis (in a subgroup) was performed. Cardiac function was evaluated using left ventricular longitudinal strain (LVLS), E/e', and relative wall thickness (RWT). In addition, epicardial fat thickness (EFT) was measured to estimate visceral fat.Normal-weight patients with DM had more EFT compared with overweight/obese patients (0.66 ± 0.17 cm vs. 0.59 ± 0.22 cm, p < 0.05), despite the overlap between the groups. There was no significant difference in the prevalence of LV remodeling (p = 0.49), impaired LVLS (p = 0.22), or increased E/e' (p = 0.26), and these were consistently observed when matched for race. The majority of patients (63%) achieved ≥ 85% of percent peak-predicted VO2. At peak, there was no significant difference in peak VO2 normalized by eLBM (36.4 ± 7.7 vs. 37.8 ± 7.1 ml/kg eLBM/min, p = 0.43) while VO2 normalized by weight (23.6 ± 6.5 vs. 29.6 ± 6.7 ml/kg/min, p < 0.001) and VO2 ratio (5.7 ± 1.7 vs. 7.3 ± 2.4 METs, p = 0.001) were significantly lower in patients with obese/overweight group. There was no significant difference between patients with higher and lower EFT.Patients with DM and normal BMI have excess epicardial fat compared to those with overweight/obese. Epicardial fat was not directly linked to prevalence of subclinical dysfunction.

  View details for DOI 10.1007/s10554-023-02944-5

  View details for PubMedID 37695438

  View details for PubMedCentralID 1352345

• Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial. Diabetologia Kobayashi, Y., Long, J., Dan, S., Johannsen, N. M., Talamoa, R., Raghuram, S., Chung, S., Kent, K., Basina, M., Lamendola, C., Haddad, F., Leonard, M. B., Church, T. S., Palaniappan, L. 2023

  Abstract

  AIMS/HYPOTHESIS: Type 2 diabetes in people in the healthy weight BMI category (<25 kg/m2), herein defined as 'normal-weight type 2 diabetes', is associated with sarcopenia (low muscle mass). Given this unique body composition, the optimal exercise regimen for this population is unknown.METHODS: We conducted a parallel-group RCT in individuals with type 2 diabetes (age 18-80 years, HbA1c 47.5-118.56 mmol/mol [6.5-13.0%]) and BMI <25 kg/m2). Participants were recruited in outpatient clinics or through advertisements and randomly assigned to a 9 month exercise programme of strength training alone (ST), aerobic training alone (AER) or both interventions combined (COMB). We used stratified block randomisation with a randomly selected block size. Researchers and caregivers were blinded to participants' treatment group; however, participants themselves were not. Exercise interventions were conducted at community-based fitness centres. The primary outcome was absolute change in HbA1c level within and across the three groups at 3, 6 and 9 months. Secondary outcomes included changes in body composition at 9 months. Per adherence to recommended exercise protocol (PP) analysis included participants who completed at least 50% of the sessions.RESULTS: Among 186 individuals (ST, n=63; AER, n=58; COMB, n=65) analysed, the median (IQR) age was 59 (53-66) years, 60% were men and 83% were Asian. The mean (SD) HbA1c level at baseline was 59.6 (13.1) mmol/mol (7.6% [1.2%]). In intention-to-treat analysis, the ST group showed a significant decrease in HbA1c levels (mean [95% CI] -0.44 percentage points [-0.78, -0.12], p=0.002), while no significant change was observed in either the COMB group (-0.35 percentage points, p=0.13) or the AER group (-0.24 percentage points, p=0.10). The ST group had a greater improvement in HbA1c levels than the AER group (p=0.01). Appendicular lean mass relative to fat mass increased only in the ST group (p=0.0008), which was an independent predictor of HbA1c change (beta coefficient -7.16, p=0.01). Similar results were observed in PP analysis. Only one adverse event, in the COMB group, was considered to be possibly associated with the exercise intervention.CONCLUSIONS/INTERPRETATION: In normal-weight type 2 diabetes, strength training was superior to aerobic training alone, while no significant difference was observed between strength training and combination training for HbA1c reduction. Increased lean mass relative to decreased fat mass was an independent predictor of reduction in HbA1c level.TRIAL REGISTRATION: ClinicalTrials.gov NCT02448498.FUNDING: This study was funded by the National Institutes of Health (NIH; R01DK081371).

  View details for DOI 10.1007/s00125-023-05958-9

  View details for PubMedID 37493759

• A QUALITATIVE EVALUATION OF A UNIVERSAL HEPATITIS B SCREENING ELECTRONIC MEDICAL RECORD REMINDER TOOL AT AN ACADEMIC PRIMARY CARE NETWORK Sarnala, S., Chu, R. V., Doan, T. V., Jamal, A., Phadke, A., Hang Pham, So, R., Huang, R., Kim, G. S., Palaniappan, L., Kim, K., Srinivasan, M. SPRINGER. 2023: S329

  View details for Web of Science ID 001043057201121

• Why Are We Going Backward? Barriers to Disaggregated Racial Information in Federal Data Sets. American journal of public health Jamal, A., Srinivasan, M., Kim, G., Huang, R. J., Palaniappan, L. 2023: e1-e4

  View details for DOI 10.2105/AJPH.2023.307339

  View details for PubMedID 37319392

• Testing the Appropriateness of Diabetes Prevention and Care Information Given by the Online Conversational AI ChatGPT. Clinical diabetes : a publication of the American Diabetes Association Hong, J., Kikuta, N. T., Simos, A., Tsai, S., Lin, B., Rodriguez, F., Palaniappan, L. 2023; 41 (4): 549-552

  View details for DOI 10.2337/cd23-0026

  View details for PubMedID 37849522

  View details for PubMedCentralID PMC10577494

• Diabetes-Related Cardiovascular and All-Cause Mortality in Asian American Subgroups. JACC. Asia Shah, N. S., Khan, S. S., Carnethon, M. R., Bacong, A. M., Palaniappan, L. P. 2023; 3 (3): 365-372

  Abstract

  Asian Americans experience heterogeneity in cardiovascular risk factors and cardiovascular disease, with a particularly high burden of diabetes in several Asian subgroups.The objectives of this study were to quantify diabetes-related mortality in Asian American subgroups and compare this with Hispanic, non-Hispanic Black, and non-Hispanic White individuals.Using national-level vital statistics data and concurrent population estimates, age-standardized mortality rates and proportional mortality from diabetes-related mortality were calculated for non-Hispanic Asian (and subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Hispanic, non-Hispanic Black, and non-Hispanic White populations in the United States, 2018-2021.Diabetes-related deaths numbered 45,249 in non-Hispanic Asian, 159,279 in Hispanic, 209,281 in non-Hispanic Black, and 904,067 in non-Hispanic White individuals. Among Asian Americans, age-standardized mortality rates of diabetes-related mortality with cardiovascular disease as underlying cause ranged from 10.8 (95% CI: 9.9-11.6) per 100,000 in Japanese females to 19.9 (95% CI: 18.9-20.9) per 100,000 in Filipina females, and from 15.3 (95% CI: 13.9-16.8) per 100,000 in Korean males to 37.8 (95% CI: 36.1-39.5) per 100,000 in Filipino males. The proportion of all deaths related to diabetes was higher in all Asian subgroups (9.7%-16.4% for females; 11.8%-19.2% for males) compared with non-Hispanic Whites (8.5% for females; 10.7% for males). The highest proportion of diabetes-related deaths occurred in Filipino adults.There was an approximately 2-fold variation in diabetes-related mortality among Asian American subgroups, with Filipino adults experiencing the greatest burden. All Asian subgroups experienced higher proportional mortality for diabetes-related mortality compared with non-Hispanic White individuals.

  View details for DOI 10.1016/j.jacasi.2022.12.010

  View details for PubMedID 37323867

  View details for PubMedCentralID PMC10261884

• Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California. BMC public health Waitzfelder, B., Palaniappan, L., Varga, A., Frankland, T. B., Li, J., Daida, Y. G., Kaholokula, J. K., Bacong, A. M., Rawlings, A. M., Chung, S., Howick, C., Fortmann, S. P. 2023; 23 (1): 885

  Abstract

  Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations.The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups.The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos).Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.

  View details for DOI 10.1186/s12889-023-15795-5

  View details for PubMedID 37189145

  View details for PubMedCentralID PMC10184427

• Disparities in Adult Asthma Outcomes Among Disaggregated Asian Americans in the National Health Interview Survey Zhang, A., Soogoor, N. A., Crowther, T. J., Vohra, S., Jamal, A., Srinivasan, M., Kim, G., Kim, K., Palaniappan, L., Huang, R., Eggert, L. AMER THORACIC SOC. 2023

  View details for Web of Science ID 000995814707397

• Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review. Journal of the American College of Cardiology Brandt, E. J., Tobb, K., Cambron, J. C., Ferdinand, K., Douglass, P., Nguyen, P. K., Vijayaraghavan, K., Islam, S., Thamman, R., Rahman, S., Pendyal, A., Sareen, N., Yong, C., Palaniappan, L., Ibebuogu, U., Tran, A., Bacong, A. M., Lundberg, G., Watson, K. 2023; 81 (14): 1368-1385

  Abstract

  Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.

  View details for DOI 10.1016/j.jacc.2023.01.042

  View details for PubMedID 37019584

• Locking the Revolving Door: Racial Disparities in Cardiovascular Disease. Journal of the American Heart Association Velarde, G., Bravo-Jaimes, K., Brandt, E. J., Wang, D., Douglass, P., Castellanos, L. R., Rodriguez, F., Palaniappan, L., Ibebuogu, U., Bond, R., Ferdinand, K., Lundberg, G., Thaman, R., Vijayaraghavan, K., Watson, K. 2023: e025271

  Abstract

  Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.

  View details for DOI 10.1161/JAHA.122.025271

  View details for PubMedID 36942617

• Moving outside the board room: A proof-of-concept study on the impact of walking while negotiating. PloS one Oppezzo, M., Neale, M. A., Gross, J. J., Prochaska, J. J., Schwartz, D. L., Aikens, R. C., Palaniappan, L. 2023; 18 (3): e0282681

  Abstract

  Negotiation is a consequential activity that can exacerbate power differentials, especially for women. While traditional contexts can prime stereotypical gender roles and promote conditions that lead to performance differences, these can be mitigated by context shifts. This proof-of-concept study explores whether an easy-to-apply context shift, moving from seated indoors to walking outside, can help improve the quality of negotiated interactions. Here we examine walking's effects on negotiation and relational outcomes as well as experienced emotions, moderated by gender.Same-gender pairs were randomly assigned to either sitting or walking as either candidate or recruiter negotiating a job offer.Eighty-one pairs of graduate students or community members participated: sitting pairs: 27 women, 14 men; walking pairs: 23 women, 17 men.Participants negotiated either while seated (across from each other) or walking (side by side along a path).We measured: negotiation performance (total points) and outcome equity (difference between negotiating party points); subjective outcomes of positive emotions, negative emotions, mutual liking, and mutual trust. With mixed effects models, we tested main effects of condition, gender, and interaction of condition x gender.Relative to sitting, walking was associated with: increased outcome equality for women, but decreased for men (B = 3799.1, SE = 1679.9, p = .027); decreased negative emotions, more for women than men (IRR = .83, 95% CI:[.69,1.00], p = .046); and greater mutual liking for both genders (W = 591.5, p-value = 0.027). No significant effects were found for negotiation point totals, positive emotions, or mutual trust.This study provides a foundation for investigating easy-to-implement changes that can mitigate stereotyped performance differences in negotiation.

  View details for DOI 10.1371/journal.pone.0282681

  View details for PubMedID 36930666

• Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Tully, I. A., Kim, J. P., Simpson, N., Palaniappan, L., Tutek, J., Gumport, N. B., Dietch, J. R., Manber, R. 2023

  Abstract

  STUDY OBJECTIVES: To examine beliefs about prescription sleep medications (hypnotics) among individuals with insomnia disorder seeking cognitive behavioral therapy for insomnia (CBTI) and predictors of wishing to reduce use.METHODS: Baseline data was collected from 245 adults 50 years and older enrolled in the "RCT of the effectiveness of stepped-care sleep therapy in general practice (RESTING)" study. T-tests compared characteristics of prescription sleep medication users with those of non-users. Linear regression assessed predictors of patients' beliefs about sleep medication necessity and hypnotic-related concerns. Among users, we examined predictors of wishing to reduce sleep medications, including perceived hypnotic dependence, beliefs about medications, and demographic characteristics.RESULTS: Users endorsed stronger beliefs about the necessity of sleep medications and less concern about potential harms than non-users (p < .01). Stronger dysfunctional sleep-related cognitions predicted greater beliefs about necessity and concern about use (p < .01). Patients wishing to reduce sleep medications reported greater perceived hypnotic dependence than those disinterested in reduction (p < .001). Self-reported dependence severity was the strongest predictor of wishing to reduce use (p = .002).CONCLUSIONS: Despite expressing strong beliefs about necessity, and comparatively less concern about taking sleep medications, three-quarters of users wished to reduce prescription hypnotics. Results may not generalize to individuals with insomnia not seeking non-pharmacological treatments. Upon completion, the RESTING study will provide information about the extent to which therapist-led and digital CBTI contribute to prescription hypnotic reduction.CLINICAL TRIAL REGISTRY: Registry: ClinicalTrials.gov; Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING); URL: https://clinicaltrials.gov/ct2/show/NCT03532282; Identifier: NCT03532282.

  View details for DOI 10.5664/jcsm.10552

  View details for PubMedID 36883379

• Toward precision sleep medicine: variations in sleep outcomes among disaggregated Asian Americans in the National Health Interview Survey (2006-2018). Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Wang, R. Z., Jamal, A., Wang, Z., Dan, S., Srinivasan, M., Kim, G., Long, J., Palaniappan, L., Singh, J., Eggert, L. E. 2023

  Abstract

  STUDY OBJECTIVES: Asian Americans (AAs) report higher rates of insufficient sleep than non-Hispanic Whites (NHWs). It is unclear how sleep outcomes differ among disaggregated Asian subgroups.METHODS: The National Health Interview Survey (NHIS) (2006-2018) was used to analyze self-reported sleep duration and quality measures for AA subgroups (Chinese [n=11,056], Asian Indian [n=11,249], Filipino [n = 13,211], and other Asians [n = 21,767]). Outcomes included hours of sleep per day, the number of days reporting trouble falling asleep, staying asleep, waking up rested, and taking sleep medication in the past week. Subsetted multivariate logistic regression was used to assess factors impacting sleep outcomes by ethnicity.RESULTS: 29.2% of NHWs, 26.4% of Chinese, 24.5% of Asian Indians, and 38.4% of Filipinos reported insufficient sleep duration. Filipinos were less likely to report sufficient sleep duration (OR 0.58, [CI95% 0.53-0.63]) and more likely to report trouble falling asleep (1.19, [1.04-1.36]) than NHWs. Chinese and Asian Indians had less trouble staying asleep ((0.66, [0.57-0.76]), (0.50, [0.43-0.58])) and falling asleep ((0.77, [0.67-0.90]), (0.71, [0.61-0.81]) than NHWs, and Asian Indians were more likely to wake feeling well rested (1.71, [1.51-1.92]). All Asian subgroups were less likely to report using sleep medications than NHWs. Foreign-born status had a negative association with sufficient sleep duration in Filipinos, but a positive association in Asian Indians and Chinese.CONCLUSIONS: Filipinos report the highest burden of poor sleep outcomes and Asian Indians report significantly better sleep outcomes. These findings highlight the importance of disaggregating Asian ethnic subgroups to address their health needs.

  View details for DOI 10.5664/jcsm.10558

  View details for PubMedID 36883375

• WHO ARE WE MISSING? REPORTING OF TRANSGENDER AND GENDER EXPANSIVE POPULATIONS IN CLINICAL TRIALS Rice, E., Lan, R., Nunes, J., Shah, R., Echols, M. R., Lunn, M., Bryant, L., Lewis, E. F., Awad, C., Idris, M. Y., Clark, K., Periyakoil, V., Cruz, E., Chen, J., Brown-Johnson, C., Palaniappan, L. P., Wang, P. J. ELSEVIER SCIENCE INC. 2023: 119

  View details for Web of Science ID 000990866100120

• PATTERNS AND GAPS IN GUIDELINE-DIRECTED STATIN USE FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN DISAGGREGATED HISPANIC AND ASIAN SUBGROUPS Sarraju, A., Yan, S., Huang, Q., Dudum, R., Palaniappan, L. P., Rodriguez, F. ELSEVIER SCIENCE INC. 2023: 1785

  View details for Web of Science ID 000990866101797

• DISABILITIES REPORTING IN CLINICAL TRIALS. HOW ARE WE DOING? Lan, R., Rice, E., Nunes, J., Shah, R., Joseph, I. E., Echols, M. R., Echols, M. R., Lunn, M., Bryant, L., Lewis, E. F., Awad, C., Idris, M. Y., Clark, K., Periyakoil, V., Cruz, E., Chen, J., Brown-Johnson, C., Palaniappan, L. P., Wang, P. J. ELSEVIER SCIENCE INC. 2023: 172

  View details for Web of Science ID 000990866100173

• Disparities and Trends in Routine Adult Vaccination Rates Among Disaggregated Asian American Subgroups, National Health Interview Survey 2006-2018. AJPM focus Wang, Z., Jamal, A., Wang, R., Dan, S., Kappagoda, S., Kim, G., Palaniappan, L., Long, J., Singh, J., Srinivasan, M. 2023; 2 (1): 100044

  Abstract

  Vaccination rates may be improved through culturally tailored messages, but little is known about them among disaggregated Asian American subgroups. We assessed the vaccination rates for key vaccines among these subgroups.Using the National Health Interview Survey, we analyzed recent vaccination rates (2015-2018, n=188,250) and trends (2006-2018) among Asians (Chinese [n=3,165], Asian Indian [n=3,525], Filipino [n=3,656], other Asian [n=5,819]) and non-Hispanic White adults (n=172,085) for 6 vaccines (the human papillomavirus, hepatitis B, pneumococcal, influenza, tetanus-diphtheria [tetanus], and shingles vaccines). We controlled demographic, socioeconomic, and health-related variables in multivariable logistic regression and predicted marginal modeling analyses. We also computed vaccination rates among Asian American subgroups on the 2015-2018 National Health Interview Survey data stratified by foreign-born and U.S.-born status. We used Joinpoint regression to analyze trends in vaccination rates. All analyses were conducted in 2021 and 2022.Among Asians, shingles (29.2%; 95% CI=26.6, 32.0), tetanus (53.7%; 95% CI=51.8, 55.6), and pneumococcal (53.8%; 95% CI=50.1, 57.4) vaccination rates were lower than among non-Hispanic Whites. Influenza (47.9%; 95% CI=46.2, 49.6) and hepatitis B (40.5%; 95% CI=39.0, 42.7) vaccination rates were similar or higher than among non-Hispanic Whites (48.4%; 95% CI=47.9, 48.9 and 30.7%; 95% CI=30.1, 31.3, respectively). Among Asians, we found substantial variations in vaccination rates and trends. For example, Asian Indian women had lower human papillomavirus vaccination rates (12.9%; 95% CI=9.1, 18.0) than all other Asian subgroups (Chinese: 37.9%; 95% CI=31.1, 45.2; Filipinos: 38.7%; 95% CI=29.9, 48.3; other Asians: 30.4%; 95% CI=24.8, 36.7) and non-Hispanic Whites (36.1%; 95% CI=34.8, 37.5). Being male, having lower educational attainment and income, having no health insurance or covered by public health insurance only, and lower frequency of doctor visits were generally associated with lower vaccine uptakes. Foreign-born Asian aggregate had lower vaccination rates than U.S.-born Asian aggregate for all vaccines except for influenza. We also found subgroup-level differences in vaccination rates between foreign-born and U.S.-born Asians. We found that (1) foreign-born Chinese, Asian Indians, and other Asians had lower human papillomavirus and hepatitis B vaccination rates; (2) foreign-born Chinese and Filipinos had lower pneumococcal vaccination rates; (3) foreign-born Chinese and Asian Indians had lower influenza vaccination rates; and (4) all foreign-born Asian subgroups had lower tetanus vaccination rates.Vaccination rates and trends differed among Asian American subgroups. Culturally tailored messaging and interventions may improve vaccine uptakes.

  View details for DOI 10.1016/j.focus.2022.100044

  View details for PubMedID 37789943

  View details for PubMedCentralID PMC10546520

• Association of Acculturation with Cardiovascular Risk Factors in Asian-American Subgroups. American journal of preventive cardiology Li, Y., Zhu, A., LE, A., Singh, J., Palaniappan, L. P., Srinivasan, M., Shah, N. S., Wong, S. S., Elfassy, T., Valero-Elizondo, J., Yang, E. 2023; 13: 100437

  Abstract

  Objective: This cross-sectional study aims to better understand the heterogeneous associations of acculturation level on CV risk factors among disaggregated Asian subgroups. We hypothesize that the association between acculturation level and CV risk factors will differ significantly by Asian subgroup.Methods: We used the National Health Interview Survey (NHIS), a nationally representative US survey, years 2014-18. Acculturation was defined using: (a) years in the US, (b) US citizenship status, and (c) level of English proficiency. We created an acculturation index, categorized into low vs. high (scores of 0-3 and 4, respectively). Self-reported CV risk factors included diabetes, high cholesterol, hypertension, obesity, tobacco use, and sufficient physical activity. Rao-Scott Chi Square was used to compare age-standardized, weighted prevalence of CV risk factors between Asian subgroups. We used logistic regression analysis to assess associations between acculturation and CV risk factors, stratified by Asian subgroup.Results: The study sample consisted of 6,051 adults ≥ 18 years of age (53.9% female; mean age 46.6 [SE 0.33]). The distribution by race/ethnicity was Asian Indian 26.9%, Chinese 22.8%, Filipino 18.1%, and other Asian 32.3%. The association between acculturation and CV risk factors differed by Asian subgroups. From multivariable adjusted models, high vs. low acculturation was associated with: high cholesterol amongst Asian Indian (OR=1.57, 95% CI: 1.11, 2.37) and other Asian (OR=1.48, 95% CI: 1.10, 2.01) adults, obesity amongst Filipino adults (OR= 1.62, 95% CI: 1.07, 2.45), and sufficient physical activity amongst Chinese (OR= 1.54, 95% CI: 1.09, 2.19) and Filipino adults (OR=1.58, 95% CI: 1.10, 2.27).Conclusion: This study demonstrates that acculturation is heterogeneously associated with higher prevalence of CV risk factors among Asian subgroups. More studies are needed to better understand these differences that can help to inform targeted, culturally specific interventions.

  View details for DOI 10.1016/j.ajpc.2022.100437

  View details for PubMedID 36545389

• Design and Rationale of RE-ENERGIZE FONTAN: RandomizEd Exercise iNtERvention desiGned to maximIZE fitness in FONTAN patients. American heart journal Tierney, E. S., Palaniappan, L., Leonard, M., Long, J., Myers, J., Dávila, T., Lui, M. C., Kogan, F., Olson, I., Punn, R., Desai, M., Schneider, L. M., Wang, C. H., Cooke, J. P., Bernstein, D. 2023

  Abstract

  In this manuscript, we describe the design and rationale of a randomized controlled trial in pediatric Fontan patients to test the hypothesis that a live-video-supervised exercise (aerobic+resistance) intervention will improve cardiac and physical capacity; muscle mass, strength, and function; and endothelial function. Survival of children with single ventricles beyond the neonatal period has increased dramatically with the staged Fontan palliation. Yet, long-term morbidity remains high. By age 40, 50% of Fontan patients will have died or undergone heart transplantation. Factors that contribute to onset and progression of heart failure in Fontan patients remain incompletely understood. However, it is established that Fontan patients have poor exercise capacity which is associated with a greater risk of morbidity and mortality. Furthermore, decreased muscle mass, abnormal muscle function, and endothelial dysfunction in this patient population is known to contribute to disease progression. In adult patients with two ventricles and heart failure, reduced exercise capacity, muscle mass, and muscle strength are powerful predictors of poor outcomes, and exercise interventions can not only improve exercise capacity and muscle mass, but also reverse endothelial dysfunction. Despite these known benefits of exercise, pediatric Fontan patients do not exercise routinely due to their chronic condition, perceived restrictions to exercise, and parental overprotection. Limited exercise interventions in children with congenital heart disease have demonstrated that exercise is safe and effective; however, these studies have been conducted in small, heterogeneous groups, and most had few Fontan patients. Critically, adherence is a major limitation in pediatric exercise interventions delivered on-site, with adherence rates as low as 10%, due to distance from site, transportation difficulties, and missed school or workdays. To overcome these challenges, we utilize live-video conferencing to deliver the supervised exercise sessions. Our multidisciplinary team of experts will assess the effectiveness of a live-video-supervised exercise intervention, rigorously designed to maximize adherence, and improve key and novel measures of health in pediatric Fontan patients associated with poor long-term outcomes. Our ultimate goal is the translation of this model to clinical application as an "exercise prescription" to intervene early in pediatric Fontan patients and decrease long-term morbidity and mortality.

  View details for DOI 10.1016/j.ahj.2023.02.006

  View details for PubMedID 36796574

• Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system. BMC public health Li, J., Chhoa, D., Palaniappan, L., Hays, K. J., Pressman, A., Wang, N. E. 2023; 23 (1): 251

  Abstract

  BACKGROUND: The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by Asian Americans and NH/PIs ethnic subgroups.METHODS: This retrospective, cross-sectional observational study aimed to assess variation of Asian Americans and NH/PIs COVID-19 testing and outcomes compared to non-Hispanic Whites (NHW). The study utilized data from the electronic health records (EHR) and the COVID-19 Universal Registry for Vital Evaluations (CURVE) from all patients tested for SARS-CoV-2 (n=556,690) at a large, health system in Northern and Central California between February 20, 2020 and March 31, 2021. Chi-square tests were used for testing differences in the severity of COVID-19 (hospitalization, ICU admission, death) and patient demographic and clinical characteristics across the Asian Americans and NH/PIs subgroups and NHW. Unadjusted and adjusted Odds Ratios (ORs) were estimated for measuring effect of race ethnicity on severity of COVID-19 using multivariable logistic regression.RESULTS: Of the entire tested population, 70,564/556,690 (12.7%) tested positive for SARS-CoV-2. SARS-CoV-2 positivity of Asian subgroups varied from 4% in the Chinese and Korean populations, to 11.2%, 13.5%, and 12.5% for Asian Indian, Filipino, and "other Asian" populations respectively. Pacific Islanders had the greatest subgroup test positivity at 20.1%. Among Asian Americans and NH/PIs patients with COVID-19 disease, Vietnamese (OR=2.06, 95% CI=1.30-3.25), "Other Asian" (OR=2.13, 95% CI=1.79-2.54), Filipino (OR=1.78, 95% CI=1.34-2.23), Japanese (OR=1.78, 95% CI=1.10-2.88), and Chinese (OR=1.73, 95% CI=1.34-2.23) subgroups had almost double the odds of hospitalization compared to NHW. Pacific Islander (OR=1.58, 95% CI=1.19-2.10) and mixed race subgroups (OR=1.55, 95% CI=1.10-2.20) had more than one and a half times odds of hospitalization compared to NHW. Adjusted odds of ICU admission or death among hospitalized patients by different Asian subgroups varied but were not statistically significant.CONCLUSIONS: Variation of COVID-19 testing and hospitalization by Asian subgroups was striking in our study. A focus on the Asian Americans and NH/PIs population with disaggregation of subgroups is crucial to understand nuances of health access, utilization, and outcomes among subgroups to create health equity for these underrepresented populations.

  View details for DOI 10.1186/s12889-023-15089-w

  View details for PubMedID 36747155

• Asthma heterogeneity amongst Asian American children: the California Health Interview Survey Chen, M., Bacong, A., Kikuta, N., Datir, R., Chen, S., Camargo, C., Srinivasan, M., Palaniappan, L., Arroyo, A. MOSBY-ELSEVIER. 2023: AB75

  View details for Web of Science ID 000991651900228

• DISMANTLING THE MODEL MINORITY MYTH: A DESCRIPTIVE ANALYSIS OF OUTCOMES IN ASIAN AMERICAN, NATIVE HAWAIIAN AND PACIFIC ISLANDER VERY LOW BIRTH WEIGHT INFANTS IN CALIFORNIA Razdan, S., Cui, X., Bane, S., Carmichael, S. L., Shariff-Marco, S., Magana, J., Gomez, S., Main, E., Palaniappan, L., Profit, J. SAGE PUBLICATIONS LTD. 2023: NP394-NP395

  View details for Web of Science ID 000972423800324

• Endothelial Cell-Specific Molecule-1 Inhibits Albuminuria in Diabetic Mice. Kidney360 Zheng, X., Higdon, L., Gaudet, A., Shah, M., Balistieri, A., Li, C., Nadai, P., Palaniappan, L., Yang, X., Santo, B., Ginley, B., Wang, X. X., Myakala, K., Nallagatla, P., Levi, M., Sarder, P., Rosenberg, A., Maltzman, J. S., de Freitas Caires, N., Bhalla, V. 2022; 3 (12): 2059-2076

  Abstract

  Background: Diabetic kidney disease (DKD) is the most common cause of kidney failure in the world, and novel predictive biomarkers and molecular mechanisms of disease are needed. Endothelial cell-specific molecule-1 (Esm-1) is a secreted proteoglycan that attenuates inflammation. We previously identified that a glomerular deficiency of Esm-1 associates with more pronounced albuminuria and glomerular inflammation in DKD-susceptible relative to DKD-resistant mice, but its contribution to DKD remains unexplored.Methods: Using hydrodynamic tail-vein injection, we overexpress Esm-1 in DKD-susceptible DBA/2 mice and delete Esm-1 in DKD-resistant C57BL/6 mice to study the contribution of Esm-1 to DKD. We analyze clinical indices of DKD, leukocyte infiltration, podocytopenia, and extracellular matrix production. We also study transcriptomic changes to assess potential mechanisms of Esm-1 in glomeruli.Results: In DKD-susceptible mice, Esm-1 inversely correlates with albuminuria and glomerular leukocyte infiltration. We show that overexpression of Esm-1 reduces albuminuria and diabetes-induced podocyte injury, independent of changes in leukocyte infiltration. Using a complementary approach, we find that constitutive deletion of Esm-1 in DKD-resistant mice modestly increases the degree of diabetes-induced albuminuria versus wild-type controls. By glomerular RNAseq, we identify that Esm-1 attenuates expression of kidney disease-promoting and interferon (IFN)-related genes, including Ackr2 and Cxcl11.Conclusions: We demonstrate that, in DKD-susceptible mice, Esm-1 protects against diabetes-induced albuminuria and podocytopathy, possibly through select IFN signaling. Companion studies in patients with diabetes suggest a role of Esm-1 in human DKD.

  View details for DOI 10.34067/KID.0001712022

  View details for PubMedID 36591362

• Effectiveness of a Community-Based Structured Physical Activity Program for Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA network open Mukherji, A. B., Lu, D., Qin, F., Hedlin, H., Johannsen, N. M., Chung, S., Kobayashi, Y., Haddad, F., Lamendola, C., Basina, M., Talamoa, R., Myers, J., Palaniappan, L. 2022; 5 (12): e2247858

  Abstract

  The efficacy of physical activity interventions among individuals with type 2 diabetes has been established; however, practical approaches to translate and extend these findings into community settings have not been well explored.To test the effectiveness of providing varying frequencies of weekly structured exercise sessions to improve diabetes control.The IMPACT (Initiate and Maintain Physical Activity in Communities Trial) study was a controlled randomized clinical trial (randomization occurred from October 2016 to April 2019) that included a 6-month, structured exercise intervention either once or thrice weekly vs usual care (UC; advice only). The exercise intervention was conducted at community-based fitness centers. Follow-up visits were conducted in a university research clinic. Participants included adults with type 2 diabetes (hemoglobin A1c [HbA1c] 6.5%-13.0%, not taking insulin, and no precluding health issues). Data analysis was performed from January to April 2022.A once-weekly structured exercise group, a thrice-weekly structured exercise group, or UC.The primary outcome was HbA1c at 6 months.A total of 357 participants (143 women [40.1%]) with a mean (SD) age of 57.4 (11.1) years were randomized (119 each to the UC, once-weekly exercise, and thrice-weekly exercise groups). There was no significant difference in HbA1c change by study group in the intention-to-treat analysis at 6 months. Specifically, HbA1c changed by -0.23% (95% CI, -0.48% to 0.01%) in the thrice-weekly exercise group and by -0.16% (95% CI, -0.41% to 0.09%) in the once-weekly exercise group. A total of 62 participants (52.1%) in the once-weekly exercise group and 56 participants (47.1%) in the thrice-weekly exercise group were at least 50% adherent to the assigned structured exercise regimen and were included in the per-protocol analysis. Per-protocol analysis showed that HbA1c changed by -0.35% (95% CI, -0.60% to -0.10%; P = .005) at 3 months and by -0.38% (95% CI, -0.65% to -0.12%; P = .005) at 6 months in the thrice-weekly exercise group compared with UC. There was no significant decrease in HbA1c in the once-weekly exercise group. The exercise intervention was effective in improving self-reported minutes of metabolic equivalent tasks per week for participants in the thrice-weekly exercise group (both overall and per protocol).Although the intervention was not effective in the intention-to-treat analysis, participants in the thrice-weekly exercise group who attended at least 50% of the sessions during the 6-month exercise intervention program improved HbA1c levels at 6 months. Future efforts should focus on improving adherence to thrice-weekly structured exercise programs to meet exercise guidelines.ClinicalTrials.gov Identifier: NCT02061579.

  View details for DOI 10.1001/jamanetworkopen.2022.47858

  View details for PubMedID 36542382

• Risk factors and pregnancy outcomes vary among Asian American, Native Hawaiian, and Pacific Islander individuals giving birth in California. Annals of epidemiology Bane, S., Abrams, B., Mujahid, M., Ma, C., Shariff-Marco, S., Main, E., Profit, J., Xue, A., Palaniappan, L., Carmichael, S. L. 2022

  Abstract

  OBJECTIVE: To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.METHODS: Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007-2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compared to frequencies for the total group (n=904,232).RESULTS: AANHPI groups varied significantly from each other and the combined total regarding indicators of social disadvantage (e.g., range for high school-level educational or less: 6.4% Korean-55.8% Samoan) and sociodemographic factors (e.g., maternal age <20 years: 0.2% Chinese-8.8% Guamanian) that are related to adverse pregnancy outcomes. Perinatal outcomes varied significantly (e.g., severe maternal morbidity: 1.2% Korean-1.9% Filipino). No single group consistently had risk factors or outcome prevalence at the extremes, i.e., no group was consistently better or worse off across examined factors.CONCLUSIONS: Substantial variability in perinatal risk factors and outcomes exists across AANHPI groups. Aggregation into "AANHPI" is not appropriate for outcome reporting.

  View details for DOI 10.1016/j.annepidem.2022.09.004

  View details for PubMedID 36115627

• Cardiovascular Risk Management in the South Asian Patient: A Review. Health sciences review (Oxford, England) Shah, K. S., Patel, J., Rifai, M. A., Agarwala, A., Bhatt, A. B., Levitzky, Y. S., Palaniappan, L. 2022; 4

  Abstract

  South Asians represent a growing percentage of the diverse population in the U.S. and are disproportionately impacted by a greater burden of aggressive and premature cardiovascular disease. There are multiple potential explanations for these findings including a high prevalence of traditional risk factors (particularly diabetes, dyslipidemia, and obesity), a genetic predisposition, and unique lifestyle factors. In this review, we discuss the cardiovascular risk stratification and disease management goals for South Asian adults. We review the pharmacologic and non-pharmacologic interventions studied in this population and discuss the role of specialized clinics and digital outreach to improve care for this vulnerable group of patients.

  View details for DOI 10.1016/j.hsr.2022.100045

  View details for PubMedID 36438886

• Proportional Mortality From Ischemic Heart Disease Among Asian American Subgroups, From 2018 to 2020. JAMA internal medicine Shah, N. S., Palaniappan, L. P., Khan, S. S. 2022

  View details for DOI 10.1001/jamainternmed.2022.3616

  View details for PubMedID 36036927

• Associations of Clinical and Social Risk Factors With Racial Differences in Premature Cardiovascular Disease CIRCULATION Shah, N. S., Ning, H., Petito, L. C., Kershaw, K. N., Bancks, M. P., Reis, J. P., Rana, J. S., Sidney, S., Jacobs, D. R., Kiefe, C., Carnethon, M. R., Lloyd-Jones, D. M., Allen, N. B., Khan, S. S. 2022; 146 (3): 201-210

  View details for DOI 10.1161/CIRCULATIONAHA.121.058311

  View details for Web of Science ID 000823965300010

• Multi-dimensional characterization of prediabetes in the Project Baseline Health Study. Cardiovascular diabetology Chatterjee, R., Kwee, L. C., Pagidipati, N., Koweek, L. H., Mettu, P. S., Haddad, F., Maron, D. J., Rodriguez, F., Mega, J. L., Hernandez, A., Mahaffey, K., Palaniappan, L., Shah, S. H., Project Baseline Health Study 2022; 21 (1): 134

  Abstract

  BACKGROUND: We examined multi-dimensional clinical and laboratory data in participants with normoglycemia, prediabetes, and diabetes to identify characteristics of prediabetes and predictors of progression from prediabetes to diabetes or reversion to no diabetes.METHODS: The Project Baseline Health Study (PBHS) is a multi-site prospective cohort study of 2502 adults that conducted deep clinical phenotyping through imaging, laboratory tests, clinical assessments, medical history, personal devices, and surveys. Participants were classified by diabetes status (diabetes [DM], prediabetes [preDM], or no diabetes [noDM]) at each visit based on glucose, HbA1c, medications, and self-report. Principal component analysis (PCA) was performed to create factors that were compared across groups cross-sectionally using linear models. Logistic regression was used to identify factors associated with progression from preDM to DM and for reversion from preDM to noDM.RESULTS: At enrollment, 1605 participants had noDM; 544 had preDM; and 352 had DM. Over 4 years of follow-up, 52 participants with preDM developed DM and 153 participants reverted to noDM. PCA identified 33 factors composed of clusters of clinical variables; these were tested along with eight individual variables identified a priori as being of interest. Six PCA factors and six a priori variables significantly differed between noDM and both preDM and DM after false discovery rate adjustment for multiple comparisons (q<0.05). Of these, two factors (one comprising glucose measures and one of anthropometry and physical function) demonstrated monotonic/graded relationships across the groups, as did three a priori variables: ASCVD risk, coronary artery calcium, and triglycerides (q<10-21 for all). Four factors were significantly different between preDM and noDM, but concordant or similar between DM and preDM: red blood cell indices (q=8*10-10), lung function (q=2*10-6), risks of chronic diseases (q=7*10-4), and cardiac function (q=0.001), along with a priori variables of diastolic function (q=1*10-10), sleep efficiency (q=9*10-6) and sleep time (q=6*10-5). Two factors were associated with progression from prediabetes to DM: anthropometry and physical function (OR [95% CI]: 0.6 [0.5, 0.9], q=0.04), and heart failure and c-reactive protein (OR [95% CI]: 1.4 [1.1, 1.7], q=0.02). The anthropometry and physical function factor was also associated with reversion from prediabetes to noDM: (OR [95% CI]: 1.9 [1.4, 2.7], q=0.02) along with a factor of white blood cell indices (OR [95% CI]: 0.6 [0.4, 0.8], q=0.02), and the a priori variables ASCVD risk score (OR [95% CI]: 0.7 [0.6, 0.9] for each 0.1 increase in ASCVD score, q=0.02) and triglycerides (OR [95% CI]: 0.9 [0.8, 1.0] for each 25mg/dl increase, q=0.05).CONCLUSIONS: PBHS participants with preDM demonstrated pathophysiologic changes in cardiac, pulmonary, and hematology measures and declines in physical function and sleep measures that precede DM; some changes predicted an increased risk of progression to DM. A factor with measures of anthropometry and physical function was the most important factor associated with progression to DM and reversion to noDM. Future studies may determine whether these changes elucidate pathways of progression to DM and related complications and whether they can be used to identify individuals at higher risk of progression to DM for targeted preventive interventions. Trial registration ClinicalTrials.gov NCT03154346.

  View details for DOI 10.1186/s12933-022-01565-x

  View details for PubMedID 35850765

• Effect of race on opioid drug overdose deaths in the United States: an observational cross-sectional study. British journal of anaesthesia Le, A. D., Li, Y., Zhu, A., Singh, J., Xu, J. Y., Srinivasan, M., Palaniappan, L. P., Long, J., Gross, E. R. 2022

  View details for DOI 10.1016/j.bja.2022.06.005

  View details for PubMedID 35787800

• Patient and Health Professional Perceptions of Telemonitoring for Hypertension Management: Qualitative Study. JMIR formative research Baratta, J., Brown-Johnson, C., Safaeinili, N., Goldman Rosas, L., Palaniappan, L., Winget, M., Mahoney, M. 2022; 6 (6): e32874

  Abstract

  BACKGROUND: Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of the US adult population; however, only 30% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs, such as remote BP monitoring, may improve hypertension management.OBJECTIVE: From March 2018 to December 2018, Stanford implemented a precision health pilot called Humanwide, which aimed to leverage high-technology and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program's acceptability, appropriateness, feasibility, and sustainability.METHODS: We conducted semistructured interviews with 16 patients and 15 health professionals to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed the interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity.RESULTS: A total of 63% (10/16) of the patients and 40% (6/15) of the health professionals mentioned hypertension in the context of Humanwide. These participants reported that remote BP monitoring improved motivation, BP control, and overall clinic efficiency. The health professionals discussed feasibility challenges, including the time needed to analyze BP data and provide individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased patient use of remote BP monitoring over time.CONCLUSIONS: Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and health professionals and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing electronic medical record integration of BP measurements, and finding more user-friendly BP cuffs.

  View details for DOI 10.2196/32874

  View details for PubMedID 35687380

• ASSOCIATIONS BETWEEN ANHEDONIA AND MALADAPTIVE BELIEFS ABOUT SLEEP IN MIDDLE AGE AND OLDER ADULTS WITH INSOMNIA DISORDER Tully, I., Tutek, J., Gumport, N., Simpson, N., Dietch, J., Palaniappan, L., Manber, R. OXFORD UNIV PRESS INC. 2022: A286-A287

  View details for Web of Science ID 000838094800648

• PREFERENCE FOR DIGITAL CBTI: CHANGES DUE TO THE COVID-19 PANDEMIC IN A RANDOMIZED CONTROLLED TRIAL OF CBTI FOR MIDDLE AGED AND OLDER ADULTS Gumport, N., Tutek, J., Simpson, N., Tully, I., Dietch, J., Zulman, D., Rosas, L., Palaniappan, L., Manber, R. OXFORD UNIV PRESS INC. 2022: A206-A207

  View details for Web of Science ID 000838094800463

• PRESCRIBING PATTERNS FOR HYPNOTIC MEDICATION AMONG ADULTS SEEKING CBTI TREATMENT: A PRELIMINARY REPORT FROM THE RESTING STUDY Simpson, N., Kim, J., Tully, I., Dietch, J., Tutek, J., Gumport, N., Palaniappan, L., Rosas, L., Zulman, D., Manber, R. OXFORD UNIV PRESS INC. 2022: A212

  View details for Web of Science ID 000838094800475

• PREDICTORS OF RESPONSE TO DIGITAL CBTI IN A RANDOMIZED CONTROLLED TRIAL OF MIDDLE AGED AND OLDER ADULTS WITH INSOMNIA Gumport, N., Tutek, J., Tully, I., Simpson, N., Dietch, J., Zulman, D., Rosas, L., Palaniappan, L., Manber, R. OXFORD UNIV PRESS INC. 2022: A207

  View details for Web of Science ID 000838094800464

• THE FIRST STEP OF A TRIAGED STEPPED-CARE DELIVERY OF CBTI: A PRELIMINARY REPORT FROM THE RESTING STUDY Manber, R., Kim, J., Simpson, N., Tully, I., Tutek, J., Dietch, J., Gumport, N., Rosas, L., Zulmann, D., Palaniappan, L. OXFORD UNIV PRESS INC. 2022: A203

  View details for Web of Science ID 000838094800455

• Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups. Circulation. Cardiovascular quality and outcomes Shah, N. S., Xi, K., Kapphahn, K. I., Srinivasan, M., Au, T., Sathye, V., Vishal, V., Zhang, H., Palaniappan, L. P. 2022: 101161CIRCOUTCOMES121008651

  Abstract

  BACKGROUND: Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups.METHODS: Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017.RESULTS: Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000).CONCLUSIONS: There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.

  View details for DOI 10.1161/CIRCOUTCOMES.121.008651

  View details for PubMedID 35535589

• Impact of US Opioid Drug Overdose by Race/Ethnicity and State in 2005-2017 Zhu, A., Li, Y., Le, A., Xu, J., Singh, J., Srinivasan, M., Palaniappan, L. P., Long, J., Gross, E. R. LIPPINCOTT WILLIAMS & WILKINS. 2022: 712-714

  View details for Web of Science ID 000840283000286

• Acculturation and Associations with Ultra-processed Food Consumption among Asian Americans: NHANES, 2011-2018. The Journal of nutrition Pachipala, K., Shankar, V., Rezler, Z., Vittal, R., Ali, S. H., Srinivasan, M. S., Palaniappan, L., Yang, E., Juul, F., Elfassy, T. 2022

  Abstract

  BACKGROUND: Ultra-processed food (UPF) consumption is linked to adverse health outcomes, including cardiovascular disease and all-cause mortality. Asian Americans (AAs) are the fastest growing ethnic group in the United States (US), yet their dietary patterns have seldom been described.OBJECTIVES: To characterize UPF consumption among AAs and determine whether acculturation is associated with increased UPF consumption.DESIGN: The National Health and Nutrition Examination Survey (NHANES) is an annual, cross-sectional survey representative of the US population. We examined 2011-2018 NHANES data which included 2404 AAs≥18 years old with valid 24-hour dietary recall. Using day 1 dietary recall data, we characterized UPF consumption as the percentage of caloric intake from UPFs, using the NOVA classification system. Acculturation was characterized by nativity status, nativity status and years in the US combined, home language, and an acculturation index. We assessed the association between acculturation and UPF consumption using linear regression analyses adjusted for age, sex, marital status, education, income, self-reported health, and self-reported diet quality.RESULTS: UPFs provided on average 39.3% (95% CI: 38.1-40.5) of total energy intake among AAs. In adjusted regression analyses, UPF consumption was 14% (95% CI: 9.5-17.5; P<0.05) greater among those with the highest vs. lowest acculturation index score, 12% (95% CI: 8.5-14.7: P<0.05) greater among those who speak English only vs. non-English only in the home, 12% (95% CI: 8.6-14.7: P<0.05) greater among US-born vs. foreign-born AAs, and 15% (95% CI: 10.7-18.3: P<0.05) greater among US-born vs. foreign-born AAs with less than ten years in the US.CONCLUSIONS: UPF consumption was common among AAs, and acculturation was strongly associated with greater proportional UPF intake. As the US-born AA population continues to grow, UPF consumption in this group is likely to increase. Further research on disaggregated AA subgroups is warranted to inform culturally tailored dietary interventions.

  View details for DOI 10.1093/jn/nxac082

  View details for PubMedID 35389482

• Determinants of Colorectal Cancer Screening among South Asian Americans. Journal of Asian health Mukherjea, A., Shariff-Marco, S., Yang, J., Tseng, W., Palaniappan, L., Li, J., Ivey, S. L., Somsouk, M., Gomez, S. L. 2022; 10 (e202202): 1-12

  Abstract

  BACKGROUND: Colorectal cancer screening rates among South Asian Americans are among the lowest of US population groups. Few population-based studies have examined determinants of screening in this population. The purpose of this study was to identify factors associated with colorectal cancer screening among South Asian Americans.METHODS: Data from the 2001-2009 California Health Interview Survey and multivariable logistic regression were used to examine determinants of being non-adherent with colorectal cancer screening recommendations. Independent variables include sociodemographic and healthcare access measures.RESULTS: Overall, 49% of 459 South Asian Americans were non-adherent to screening recommendations. Characteristics associated with non-adherence were the absence of flu shot, absence of doctor visits, sole use of non-English language at home and ≤40% life spent in the United States. In the multivariable model, screening non-adherence was associated with ≤40% life in the United States (odds ratio [95% confidence interval] 3.0 [1.4-6.5]), use of non-English at home (2.8 [1.0-7.8]) and no flu shot (2.5 [1.3-4.8]). Obese (BMI > 27.5 kg/m2) versus normal-weight patients were less likely to be non-adherent (0.4 [0.2-0.9]).CONCLUSIONS: Length of time in the United States and language spoken at home rather than English proficiency were associated with non-adherence to colorectal cancer screening, reflecting the importance of acculturation and retention of cultural values. Health conditions and behaviors reflecting more proactive healthcare utilization may reinforce the importance of provider recommendations and perceived efficacy of health prevention. Qualitative research would inform cultural tailoring necessary to improve colorectal cancer screening rates among the rapidly growing South Asian American population.

  View details for PubMedID 35909807

• RCT of the effectiveness of stepped-care sleep therapy in general practice: The RESTING study protocol. Contemporary clinical trials Manber, R., Tully, I. A., Palaniappan, L., Kim, J. P., Simpson, N., Zulman, D. M., Goldhaber-Fiebert, J. D., Rangel, E., Dietch, J. R., Rosas, L. G. 2022: 106749

  Abstract

  Cognitive behavioral therapy for insomnia (CBT-I) is an effective, non-pharmacological intervention, designated by the American College of Physicians as the first-line treatment of insomnia disorder. The current randomized controlled study uses a Hybrid-Type-1 design to compare the effectiveness and implementation potential of two approaches to delivering CBT-I in primary care. One approach offers therapy to all patients through an automated, digital CBT-I program (ONLINE-ONLY). The other is a triaged STEPPED-CARE approach that uses a simple Decision Checklist to start patients in either digital or therapist-led treatment; patients making insufficient progress with digital treatment at 2 months are switched to therapist-led treatment. We will randomize 240 individuals (age 50 or older) with insomnia disorder to ONLINE-ONLY or STEPPED-CARE arms. The primary outcomes are insomnia severity and hypnotic medication use, assessed at baseline and at months 2, 4, 6, 9, and 12 after randomization. We hypothesize that STEPPED-CARE will be superior to ONLINE-ONLY in reducing insomnia severity and hypnotic use. We also aim to validate the Decision Checklist and explore moderators of outcome. Additionally, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will use mixed methods to obtain data on the potential for future dissemination and implementation of each approach. This triaged stepped-care approach has the potential to improve sleep, reduce use of hypnotic medications, promote safety, offer convenient access to treatment, and support dissemination of CBT-I to a large number of patients currently facing barriers to accessing treatment. Clinical trial registration:NCT03532282.

  View details for DOI 10.1016/j.cct.2022.106749

  View details for PubMedID 35367385

• Vaccination patterns, disparities, and policy among Asian-Americans and Asians living in the USA Jamal, A., Wang, R., Wang, Z., Dan, S., Srinivasan, M., Kim, G., Palaniappan, L., Singh, J., Kappagoda, S. ELSEVIER SCI LTD. 2022: 27

  View details for Web of Science ID 000779259700028

• Vaccination patterns, disparities, and policy among Asian-Americans and Asians living in the USA. The Lancet. Global health Jamal, A., Wang, R., Wang, Z., Dan, S., Srinivasan, M., Kim, G., Palaniappan, L., Singh, J., Kappagoda, S. 2022; 10 Suppl 1: S27

  Abstract

  Although Asian-American individuals have higher rates of some vaccine-preventable diseases such as hepatitis B, vaccination rates among them are low compared with those of non-Hispanic White individuals. Most vaccine research looks at Asian-American people as a single category despite large within-group heterogeneity in health-seeking behaviours. Little is known about vaccination coverage among disaggregated Asian-American ethnic subgroups, although such information could inform policies focused on increasing vaccine uptake. Therefore, we aimed to assess vaccination coverage for several vaccines among disaggregated Asian-American subgroups.We examined National Health Interview Survey (NHIS) data from 2015-18 to analyse the vaccination status of Chinese, Asian Indian, Filipino, other Asian, and non-Hispanic White adults (n=253 626) for seven vaccines recommended by the US Centers for Disease Control and Prevention: human papillomavirus (HPV), hepatitis B (HBV), influenza, tetanus, tetanus-diphtheria-pertussis (Tdap), shingles, and the pneumococcal vaccine. We used NHIS data from 2006-18 (n=880 210) to analyse changes in vaccination rates for each ethnic group over time. We used logistic regression to estimate differences in vaccination rates while controlling for demographic, socioeconomic and health-related variables.Among the seven vaccines, HPV and shingles vaccines had the lowest uptake, whereas Tdap had the highest uptake among all groups. Compared with the non-Hispanic White group, Asian Indians were almost half as likely to receive the HPV vaccine (odds ratio 0·61, 95% CI 0·41-0·92), whereas Filipinos (1·51, 1·02-2·25) and other Asians (1·42, 1·02-1·97) were more likely to receive it. The Filipino (1·50, 1·21-1·88) and other Asian groups (1·42, 1·19-1·71) were more likely to receive the HBV vaccine than the non-Hispanic White group. For the influenza vaccine, the Asian Indian (1·28, 1·05-1·56), Filipino (1·44, 1·17-1·79) and other Asian (1·38, 1·16-1·65) groups were more likely to receive the vaccine than the non-Hispanic White group. For the pneumococcal vaccine, the Chinese (0·57, 0·34-0·94) and other Asian (0·66, 0·47-0·92) groups were less likely to receive the vaccine than the non-Hispanic White group.Among US adults, we found significant disparities in vaccine uptake among different Asian and Asian-American ethnic groups. US policy makers trying to improve vaccine uptake among Asian and Asian-American people could learn from successful international immunisation programmes to develop culturally appropriate interventions to improve vaccine uptake in Asian and Asian-American individuals.None.

  View details for DOI 10.1016/S2214-109X(22)00156-5

  View details for PubMedID 35362432

• Acculturation And Associations With Ultra-processed Food Consumption Among Asian Americans: NHANES, 2011-2018 Pachipala, K., Shankar, V., Rezler, Z., Vittal, R., Ali, S., Srinivasan, M., Palaniappan, L., Yang, E., Juul, F., Elfassy, T. LIPPINCOTT WILLIAMS & WILKINS. 2022

  View details for DOI 10.1161/circ.145.suppl_1.P210

  View details for Web of Science ID 000805839700407

• The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms. Clinical pharmacology and therapeutics Cooper-DeHoff, R. M., Niemi, M., Ramsey, L. B., Luzum, J. A., Tarkiainen, E. K., Straka, R. J., Gong, L., Tuteja, S., Wilke, R. A., Wadelius, M., Larson, E. A., Roden, D. M., Klein, T. E., Yee, S. W., Krauss, R. M., Turner, R. M., Palaniappan, L., Gaedigk, A., Giacomini, K. M., Caudle, K. E., Voora, D. 2022

  Abstract

  Statins reduce cholesterol, prevent cardiovascular disease, and are among the most commonly prescribed medications in the world. Statin-associated musculoskeletal symptoms (SAMS) impact statin adherence and ultimately can impede the long-term effectiveness of statin therapy. There are several identified pharmacogenetic variants that impact statin disposition and adverse events during statin therapy. SLCO1B1 encodes a transporter (SLCO1B1; alternative names include OATP1B1 or OATP-C) that facilitates the hepatic uptake of all statins. ABCG2 encodes an efflux transporter (BCRP) that modulates the absorption and disposition of rosuvastatin. CYP2C9 encodes a Phase-I drug metabolizing enzyme responsible for the oxidation of some statins. Genetic variation in each of these genes alters systemic exposure to statins (i.e., simvastatin, rosuvastatin, pravastatin, pitavastatin, atorvastatin, fluvastatin, lovastatin), which can increase the risk for SAMS. We summarize the literature supporting these associations and provide therapeutic recommendations for statins based on SLCO1B1, ABCG2, and CYP2C9 genotype with the goal of improving the overall safety, adherence and effectiveness of statin therapy. This document replaces the 2012 and 2014 Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for SLCO1B1 and simvastatin-induced myopathy.

  View details for DOI 10.1002/cpt.2557

  View details for PubMedID 35152405

• Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop. Annals of internal medicine Kanaya, A. M., Hsing, A. W., Panapasa, S. V., Kandula, N. R., G Araneta, M. R., Shimbo, D., Wang, P., Gomez, S. L., Lee, J., Narayan, K. M., Mala Mau, M. K., Bose, S., Daviglus, M. L., Hu, F. B., Islam, N., Jackson, C. L., Kataoka-Yahiro, M., Kauwe, J. S., Liu, S., Ma, G. X., Nguyen, T., Palaniappan, L., Setiawan, V. W., Trinh-Shevrin, C., Tsoh, J. Y., Vaidya, D., Vickrey, B., Wang, T. J., Wong, N. D., Coady, S., Hong, Y. 1800

  Abstract

  Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.

  View details for DOI 10.7326/M21-3729

  View details for PubMedID 34978851

• Personalizing cholesterol treatment recommendations for primary cardiovascular disease prevention. Scientific reports Sarraju, A., Ward, A., Li, J., Valencia, A., Palaniappan, L., Scheinker, D., Rodriguez, F. 2022; 12 (1): 23

  Abstract

  Statin therapy is the cornerstone of preventing atherosclerotic cardiovascular disease (ASCVD), primarily by reducing low density lipoprotein cholesterol (LDL-C) levels. Optimal statin therapy decisions rely on shared decision making and may be uncertain for a given patient. In areas of clinical uncertainty, personalized approaches based on real-world data may help inform treatment decisions. We sought to develop a personalized statin recommendation approach for primary ASCVD prevention based on historical real-world outcomes in similar patients. Our retrospective cohort included adults from a large Northern California electronic health record (EHR) aged 40-79 years with no prior cardiovascular disease or statin use. The cohort was split into training and test sets. Weighted-K-nearest-neighbor (wKNN) regression models were used to identify historical EHR patients similar to a candidate patient. We modeled four statin decisions for each patient: none, low-intensity, moderate-intensity, and high-intensity. For each candidate patient, the algorithm recommended the statin decision that was associated with the greatest percentage reduction in LDL-C after 1 year in similar patients. The overall cohort consisted of 50,576 patients (age 54.6 ± 9.8 years) with 55% female, 48% non-Hispanic White, 32% Asian, and 7.4% Hispanic patients. Among 8383 test-set patients, 52%, 44%, and 4% were recommended high-, moderate-, and low-intensity statins, respectively, for a maximum predicted average 1-yr LDL-C reduction of 16.9%, 20.4%, and 14.9%, in each group, respectively. Overall, using aggregate EHR data, a personalized statin recommendation approach identified the statin intensity associated with the greatest LDL-C reduction in historical patients similar to a candidate patient. Recommendations included low- or moderate-intensity statins for maximum LDL-C lowering in nearly half the test set, which is discordant with their expected guideline-based efficacy. A data-driven personalized statin recommendation approach may inform shared decision making in areas of uncertainty, and highlight unexpected efficacy-effectiveness gaps.

  View details for DOI 10.1038/s41598-021-03796-6

  View details for PubMedID 34996943

• Psychological Distress and Mental Health Service Utilization Disparities in Disaggregated Asian American Populations, 2006-2018 Asian American Journal of Psychology Balaraman, K. K., Dan, S., Ortega, N., Srinivasan, M., Joshi, S. V. 2022

  View details for DOI 10.1037/aap0000294

• Leading causes of death in Asian Indians in the United States (2005-2017). PloS one Fernandez Perez, C., Xi, K., Simha, A., Shah, N. S., Huang, R. J., Palaniappan, L., Chung, S., Au, T., Sharp, N., Islas, N., Srinivasan, M. 2022; 17 (8): e0271375

  Abstract

  OBJECTIVE: Asian Indians are among the fastest growing United States (US) ethnic subgroups. We characterized mortality trends for leading causes of death among foreign-born and US-born Asian Indians in the US between 2005-2017.STUDY DESIGN AND SETTING: Using US standardized death certificate data, we examined leading causes of death in 73,470 Asian Indians and 20,496,189 non-Hispanic whites (NHWs) across age, gender, and nativity. For each cause, we report age-standardized mortality rates (AMR), longitudinal trends, and absolute percent change (APC).RESULTS: We found that Asian Indians' leading causes of death were heart disease (28% mortality males; 24% females) and cancer (18% males; 22% females). Foreign-born Asian Indians had higher all-cause AMR compared to US-born (AMR 271 foreign-born, CI 263-280; 175.8 US-born, CI 140-221; p<0.05), while Asian Indian all-cause AMR was lower than that of NHWs (AMR 271 Indian, CI 263-278; 754.4 NHW, CI 753.3-755.5; p<0.05). All-cause AMR increased for foreign-born Asian Indians over time, while decreasing for US-born Asian Indians and NHWs.CONCLUSIONS: Foreign-born Asian Indians were 2.2 times more likely to die of heart disease and 1.6 times more likely to die of cancer. Asian Indian male AMR was 49% greater than female on average, although AMR was consistently lower for Asian Indians when compared to NHWs.

  View details for DOI 10.1371/journal.pone.0271375

  View details for PubMedID 35947608

• Lifting the Digital Curtain: Utilizing Social Media to Promote Health Content and Engage with Asian Populations. Journal of Asian health Yuthok, T. Y., Sales, C., Li, S. S., Li, N., Connors, K., Palaniappan, L. 2022; 2 (1)

  Abstract

  BACKGROUND/AIMS: To understand how social media can be used to improve Asian subgroup engagement in a research registry.METHODS: A 10-week social media campaign was implemented with the goal of increasing the percentage of Asian participants in the Stanford Research Registry - platforms utilized include Facebook, Instagram, and Twitter through the Stanford Center for Asian Health Research and Education accounts. Participant data was disaggregated by race and ethnicity in order to better understand the diversity among Asian subgroups.RESULTS: The percentage of Asian participants increased from 14.3% at baseline to 23.8% at the end of the campaign (525 Asian identifying individuals to 1,871). The greatest increase occurred during the general outreach phase which utilized all channels of outreach available. Frequencies of some ethnicities, such as Japanese, Korean, and Vietnamese, were higher in the Multi-Ethnic and/or Multi-Racial categories compared to their corresponding monoethnic groups.CONCLUSIONS: Social media is a powerful tool that can be leveraged for targeted recruitment - in this study we see how it can increase diversity amongst research participants and potentially be used as an effective tool for information dissemination. This work can be expanded in the future by examining other social media platforms more targeted toward Asian populations, and more thorough disaggregation to fully understand the diversity present in the Asian population.

  View details for PubMedID 36381954

• The acceptability and effect of a culturally-tailored dance intervention to promote physical activity in women of South Asian origin at risk of diabetes in the Netherlands-A mixed-methods feasibility study. PloS one Beune, E., Muilwijk, M., Jelsma, J. G., van Valkengoed, I., Teitsma-Jansen, A. M., Kumar, B., Diaz, E., Gill, J. M., Jenum, A. K., Palaniappan, L., van der Ploeg, H. P., Sheikh, A., Davidson, E., Stronks, K. 2022; 17 (2): e0264191

  Abstract

  OBJECTIVE: Populations of South Asian (SA) origin are at high risk of type 2 diabetes (T2D) and related complications. Analysis of T2D prevention interventions for these populations show that limited attention has been given to facilitating increased physical activity (PA) in a culturally appropriate manner. The aim of this feasibility study was to identify whether culturally tailored dance is acceptable to women of SA origin, and whether it may have an effect on PA and PA-related social cognitive determinants.METHODS: A community-based culturally tailored dance intervention choreographed to Bollywood music was evaluated among 26 women of SA origin in the Netherlands for 10 weeks, 2 times per week. This feasibility study was conducted as a before-after, mixed-methods study, combining data from focus groups, individual interviews, questionnaires and accelerometers.RESULTS: The majority of participants were in the age of 50-59 years and at moderate-to-high T2D risk. There was high attendance (73%), low drop out (12%) and high satisfaction scores for various program components. Key reasons for participation were the cultural appropriateness, in particular the combination of historically and emotionally embedded Indian music and dance, and the non-competitive nature of the intervention. On average, in each of the 19 one-hour sessions, participants spent 30.8 minutes in objectively assessed light intensity PA, 14.1 minutes in moderate intensity PA and 0.3 minutes in vigorous PA, and took 2,100 steps during a session. At follow-up, total moderate-to-vigorous PA increased by 7.8 minutes per day (95%CI: 3.1, 12.5) and daily steps increased by 784 (95%CI: 173, 1394), with a concomitant reduction in light PA of 12 minutes per day (95%CI: -21.9, -2.2). Positive shifts in some PA-behavioral social cognitive determinants and no negative side-effects were observed.CONCLUSIONS: Bollywood Dance appears to be a feasible, culturally acceptable and potentially effective approach to increase PA in SA women in the Netherlands. A pilot cluster RCT is needed to confirm these initial findings on effectiveness.

  View details for DOI 10.1371/journal.pone.0264191

  View details for PubMedID 35213598

• Thyroid Cancer Incidence Trends Among Filipinos in the United States. The Laryngoscope Megwalu, U. C., Osazuwa-Peters, N., Moon, P., Palaniappan, L. P. 1800

  Abstract

  OBJECTIVE: To analyze thyroid cancer incidence trends among Filipinos relative to non-Filipino Asians and non-Hispanic Whites in the US.STUDY DESIGN: Population-based analysis of cancer incidence data.METHODS: Population-based analysis of cancer incidence data from Surveillance, Epidemiology, and End Results 9 detailed Asian/Pacific Islander subgroup incidence and population datasets. Adult patients aged 20 and older with thyroid cancer diagnosed in 2004 to 2014 were included. Annual percent change (APC) of the incidence rates were calculated using joinpoint regression analysis.RESULTS: The incidence rates were 19.57 (95% CI 19.03-20.12) per 100,000 for Filipinos, 10.45 (95% CI 10.22-10.68) per 100,000 for non-Filipino Asians, and 13.94 (95% CI 13.85-14.02) per 100,000 for non-Hispanic Whites. The highest increase was seen among non-Hispanic Whites (average APC 5.04, 95% CI 4.61-5.46). Incidence rates of tumors≤2cm remained stable among Filipinos but increased in non-Filipino Asians (average APC 5.38, 95% CI 2.51-8.34) and non-Hispanic Whites (average APC 5.81 95% CI 4.52-7.11).CONCLUSION: Filipinos have high incidence of thyroid cancer compared with other racial/ethnic groups. However, non-Hispanic Whites have the highest increase in incidence rates, resulting in a significant narrowing of the gap in incidence rates between Filipinos and non-Hispanic Whites. This is most likely due to enhanced detection of small tumors in non-Hispanic Whites. Laryngoscope, 2021.

  View details for DOI 10.1002/lary.29986

  View details for PubMedID 34910822

• Shifting our stance for current COVID-19 outbreaks: A global response to an international pandemic. Journal of global health Obra, J. K., Lin, B., Palaniappan, L., Kim, G. S. 2021; 11: 03123

  View details for DOI 10.7189/jogh.11.03123

  View details for PubMedID 34956633

  View details for PubMedCentralID PMC8684779

• Cancer Mortality in US-born vs. Foreign-born Asian American Groups (2008-2017). Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Tripathi, O., He, Y., Han, B. Y., Paragas, D. G., Sharp, N., Dan, S., Srinivasan, M., Palaniappan, L. P., Thompson, C. A. 2021

  Abstract

  Background Asian Americans (AA) are the fastest growing ethnic group in the US with high proportions of immigrants. Nativity is important as cancer risk factors vary by country. We sought to understand differences in cancer mortality among AAs by nativity (foreign-born vs. US-born). Methods 98,826 AA (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) decedents with cancer-related deaths from US death certificates (2008-2017) were analyzed. Thirteen cancers that contribute significantly to AA cancer mortality were selected and categorized by etiology: tobacco-related, screen-detected, diet/obesity-related, and infection-related. 10-year age-adjusted mortality rates [AAMR (95% CI); per 100,00] and standardized mortality ratios [SMR (95% CI)] using foreign-born as the reference group were calculated. Results Overall, foreign-born AAs had higher mortality rates than US-born. Japanese US-born males had the highest tobacco-related mortality rates (Foreign-born AAMR: 43.02 [38.72, 47.31], US-born AAMR: 55.38 [53.05, 57.72]). Screen-detected death rates were higher for foreign-born than US-born, except for among Japanese males [SMR 1.28 (1.21-1.35)]. Diet/obesity-related AAMRs were higher among females than males and highest among foreign-born females. Foreign-born males and females had higher infection-related AAMRs than US-born; the highest rates were foreign-born males: Korean (AAMR 41.54 [39.54, 43.53]) and Vietnamese (AAMR 41.39 [39.68, 43.09]). Conclusions We observed substantial heterogeneity in mortality rates across AA groups and by nativity. Contrary to the Healthy Immigrant Effect, most foreign-born Asians were dying at higher rates than US-born AAs. Impact: Disaggregated analysis of AA cancers, targeted and culturally tailored cancer screening, and treatments for infections among foreign-born Asians is critical for cancer prevention efforts.

  View details for DOI 10.1158/1055-9965.EPI-21-0359

  View details for PubMedID 34697057

• Improving diversity in medical research. Nature reviews. Disease primers Sharma, A., Palaniappan, L. 2021; 7 (1): 74

  View details for DOI 10.1038/s41572-021-00316-8

  View details for PubMedID 34650078

• Achieving Equity in Asian American Healthcare: Critical Issues and Solutions. Journal of Asian health Obra, J. K., Lin, B., Đoàn, L. N., Palaniappan, L., Srinivasan, M. 2021; 1 (1)

  Abstract

  Equity is a fundamental goal of the US health care system. Asians comprise 6% of the US population, and 60% of the world's population. Less than 1% of National Institutes of Health funding is directed toward Asian health. Asian health outcomes are often worse than non-Hispanic Whites (NHWS) in America. Increasing federal and foundation resources and funding toward Asian health research could illuminate these risks and develop precision interventions to reduce known health disparities. When disaggregated by race/ethnicity, Asian health risks are even more apparent. Here, we discuss critical health outcome differences between the six major Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) comprising 80% of the US Asian population, highlighting demographic, pharmacologic, disease prevalence, and mortality outcomes. We then outline seven critical issues contributing to Asian American health disparities, including aggregated Asian health data, undersampling, invalid extrapolations, underrepresentation in clinical trials, lack of funding and awareness of disparities, and the model minority myth. Building on the successes of national public health initiatives, we propose nine leverage points to improve Asian American health including the following: obtaining disaggregated Asian health data, improved Asian health research (oversampling Asians, improving clinical trial participation, and increasing research funding), stakeholder collaboration (national and with Asian nations), community engagement, providing culturally precise health care, and expansion of the Asian American research ecosystem. Achieving health equity takes deliberate practice and does not occur by accident. By addressing critical issues that perpetuate Asian health disparities, we grow closer to understanding how to effectively improve Asian health and build a nationally unified mindset toward action that emphasizes equitable care for all.

  View details for DOI 10.59448/jah.v1i1.3

  View details for PubMedID 37872960

  View details for PubMedCentralID PMC10593109

• Disaggregating Asian American Cigarette and Alternative Tobacco Product Use: Results from the National Health Interview Survey (NHIS) 2006-2018. Journal of racial and ethnic health disparities Rao, M., Bar, L., Yu, Y., Srinivasan, M., Mukherjea, A., Li, J., Chung, S., Venkatraman, S., Dan, S., Palaniappan, L. 2021

  Abstract

  INTRODUCTION: Asian Americans suffer high rates of smoking and tobacco-related deaths, varying by ethnic group. Trends ofcigarette and alternative tobacco productuse among Asian Americans, specifically considering ethnic group, sex, and nativity, are infrequently reported.METHODS: Using National Health Interview Survey (NHIS) data from 2006-2018 and the 2016-2018 alternative tobacco supplement (e-cigarettes, cigars, smokeless tobacco, pipes), we explored cigarette and alternativetobacco productuse by Asian ethnic group (Asian Indian (n = 4373), Chinese (n = 4736), Filipino (n = 4912)) in comparison to non-Hispanic Whites (NHWs (n = 275,025)), adjusting for socioeconomic and demographic factors.RESULTS: Among 289,046 adults, 12% of Filipinos were current smokers, twice the prevalence in Asian Indians and Chinese (p < 0.001). The male-female gender difference was fivefold for Chinese (10.3% vs. 2.2%; p < 0.001), eightfold for Asian Indians (8.7% vs. 1.1%; p < 0.001), and twofold for Filipinos (16.8% vs. 9.0%). Moreover, 16.3% of US-born and 10.3% of foreign-born Filipinos were current smokers. Odds of ever using e-cigarettes, cigars, smokeless tobacco, and pipes in comparison to NHWs were lowest for Chinese (ORs 0.6, 0.5, 0.2, and 0.5).DISCUSSION: Filipinos had the highest current smoking rates of Asian ethnic groups. Though more Asian men were current smokers, the high rate of current smoking among Filipinas is concerning. More US-born Filipinos were current smokers than foreign-born, despite rates typically decreasing for US-born Asians. Investigating cultural factors contributing to less frequent use of tobacco products, such as alternative tobacco products among Chinese, may aid campaigns in curbing tobacco usage.

  View details for DOI 10.1007/s40615-021-01024-5

  View details for PubMedID 33909281

• Peripheral Oxygen Extraction and Exercise Limitation in Asymptomatic Patients with Diabetes Mellitus. The American journal of cardiology Kobayashi, Y., Christle, J. W., Contrepois, K., Nishi, T., Moneghetti, K., Cauwenberghs, N., Myers, J., Kuznetsova, T., Palaniappan, L., Haddad, F. 2021

  Abstract

  Patients with diabetes mellitus (DM) frequently present reduced exercise capacity. We aimed to explore the extent to which peripheral extraction relates to exercise capacity in asymptomatic patients with DM. We prospectively enrolled 98 asymptomatic patients with type-2 DM (mean age of 59±11 years and 56% male sex), and compared with 31 age, sex and body mass index (BMI)-matched normoglycemic controls. Cardiopulmonary exercise testing (CPX) with resting echocardiography was performed. Exercise response was assessed using peak oxygen uptake (peak VO2) and ventilatory efficiency was measured using the slope of the relationship between minute ventilation and carbon dioxide production (VE/VCO2). Peripheral extraction was calculated as the ratio of VO2to cardiac output. Cardiac function was evaluated using left ventricular longitudinal strain (LVLS), E/e', and relative wall thickness (RWT). Among patients with DM, 26 patients (27%) presented reduced percent-predicted-peak VO2(<80%) and 18 (18%) presented abnormal VE/VCO2slope (>34). There was no significant difference in peak cardiac output; peripheral extraction was lower in patients with DM compared to controls. Higher peak E/e' (beta=-0.24, p=0.004) was associated with lower peak VO2along with age, sex and BMI (R2=0.53). A network correlation map revealed the connectivity of peak VO2as a central feature and cluster analysis found LVLS, E/e', RWT and peak VO2in different clusters. In conclusion, impaired peripheral extraction may contribute to reduced peak VO2in asymptomatic patients with DM. Furthermore, cluster analysis suggests that CPX and echocardiography may be complementary for defining subclinical heart failure in patients with DM.

  View details for DOI 10.1016/j.amjcard.2021.03.011

  View details for PubMedID 33757787

• Precision Public Health Matters: An International Assessment of Communication, Preparedness, and Coordination for Successful COVID-19 Responses. American journal of public health Sales, C., Kim, Y., Kim, G., Lin, B., Palaniappan, L. 2021; 111 (3): 392–94

  View details for DOI 10.2105/AJPH.2020.306129

  View details for PubMedID 33566659

• Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care. BMC family practice Brown-Johnson, C. G., Safaeinili, N., Baratta, J., Palaniappan, L., Mahoney, M., Rosas, L. G., Winget, M. 2021; 22 (1): 28

  Abstract

  BACKGROUND: Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs.METHODS: We conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews. Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes.RESULTS: Fifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability.CONCLUSION: This is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems.

  View details for DOI 10.1186/s12875-021-01373-4

  View details for PubMedID 33530939

• Disaggregated Mortality from Gastrointestinal Cancers in Asian Americans: Analysis of United States Death Records. International journal of cancer Huang, R. J., Sharp, N., Talamoa, R., Kapphahn, K., Sathye, V., Lin, B., Srinivasan, M., Palaniappan, L. P. 2021

  Abstract

  Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003-2017, we report age-standardized mortality rates, standardized mortality ratios, and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver, and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/ijc.33490

  View details for PubMedID 33527405

• Statin Use in Older Adults with Stable Atherosclerotic Cardiovascular Disease. Journal of the American Geriatrics Society Spencer-Bonilla, G., Chung, S., Sarraju, A., Heidenreich, P., Palaniappan, L., Rodriguez, F. 2021

  Abstract

  BACKGROUND/OBJECTIVES: Older adults (>75years of age) represent two-thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi-society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD.DESIGN: Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018.SETTING: A large multi-specialty health system in Northern California.PARTICIPANTS: A total of 24,651 adults older than 75years with ASCVD.MEASUREMENTS: Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors.RESULTS: The study cohort included 24,651 patients older than 75years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins.CONCLUSIONS: Despite increasing prescription rates between 2007 and 2018, guideline-recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.

  View details for DOI 10.1111/jgs.16975

  View details for PubMedID 33410499

• Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk. Journal of general internal medicine Sarraju, A., Spencer-Bonilla, G., Chung, S., Gomez, S., Li, J., Heidenreich, P., Palaniappan, L., Rodriguez, F. 2021

  Abstract

  There remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults.To assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk.Retrospective cohort study of participants without ASCVD aged 65-79 years. Patients were stratified by age (65-69, 70-75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate- or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD.Patients aged 65-79 years without ASCVD from a Northern California health system.Statin prescriptions and incident ASCVD events.There were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate- or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23-1.63). Women (OR 0.85, 95% CI 0.81-0.89) and underweight older adults (OR 0.45, 95% CI 0.33-0.61) were also less likely to receive moderate- or high-intensity statins.Among older adults aged 65-79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate- or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.

  View details for DOI 10.1007/s11606-021-07107-7

  View details for PubMedID 34505981

• ASSOCIATIONS BETWEEN ULTRA-PROCESSED FOOD INTAKE AND CARDIOMETABOLIC HEALTH AMONG DIVERSE US ADULTS 50 OR OLDER Elfassy, T., Juul, F., Mesa, R., Palaniappan, L., Srinivasan, M., Yi, S. OXFORD UNIV PRESS. 2021: 51

  View details for Web of Science ID 000842009900198

• Digital Health Applications for Pharmacogenetic Clinical Trials. Genes Naik, H., Palaniappan, L., Ashley, E. A., Scott, S. A. 2020; 11 (11)

  Abstract

  Digital health (DH) is the use of digital technologies and data analytics to understand health-related behaviors and enhance personalized clinical care. DH is increasingly being used in clinical trials, and an important field that could potentially benefit from incorporating DH into trial design is pharmacogenetics. Prospective pharmacogenetic trials typically compare a standard care arm to a pharmacogenetic-guided therapeutic arm. These trials often require large sample sizes, are challenging to recruit into, lack patient diversity, and can have complicated workflows to deliver therapeutic interventions to both investigators and patients. Importantly, the use of DH technologies could mitigate these challenges and improve pharmacogenetic trial design and operation. Some DH use cases include (1) automatic electronic health record-based patient screening and recruitment; (2) interactive websites for participant engagement; (3) home- and tele-health visits for patient convenience (e.g., samples for lab tests, physical exams, medication administration); (4) healthcare apps to collect patient-reported outcomes, adverse events and concomitant medications, and to deliver therapeutic information to patients; and (5) wearable devices to collect vital signs, electrocardiograms, sleep quality, and other discrete clinical variables. Given that pharmacogenetic trials are inherently challenging to conduct, future pharmacogenetic utility studies should consider implementing DH technologies and trial methodologies into their design and operation.

  View details for DOI 10.3390/genes11111261

  View details for PubMedID 33114567

• The association between Asian patient race/ethnicity and lower satisfaction scores. BMC health services research Liao, L., Chung, S., Altamirano, J., Garcia, L., Fassiotto, M., Maldonado, B., Heidenreich, P., Palaniappan, L. 2020; 20 (1): 678

  Abstract

  BACKGROUND: Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings.METHODS: Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N=216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex.RESULTS: Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking.CONCLUSIONS: Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.

  View details for DOI 10.1186/s12913-020-05534-6

  View details for PubMedID 32698825

• A Summary of the 2020 Gastric Cancer Summit at Stanford University. Gastroenterology Huang, R. J., Koh, H., Hwang, J. H., Summit Leaders, Abnet, C. C., Alarid-Escudero, F., Amieva, M. R., Bruce, M. G., Camargo, M. C., Chan, A. T., Choi, I. J., Corvalan, A., Davis, J. L., Deapen, D., Epplein, M., Greenwald, D. A., Hamashima, C., Hur, C., Inadomi, J. M., Ji, H. P., Jung, H., Lee, E., Lin, B., Palaniappan, L. P., Parsonnet, J., Peek, R. M., Piazuelo, M. B., Rabkin, C. S., Shah, S. C., Smith, A., So, S., Stoffel, E. M., Umar, A., Wilson, K. T., Woo, Y., Yeoh, K. G. 2020

  View details for DOI 10.1053/j.gastro.2020.05.100

  View details for PubMedID 32707045

• Cardiopulmonary Differences Between Normal And Overweight Diabetics Christle, J. W., Kobayashi, Y., Moneghetti, K., Wheeler, M., Myers, J., Palaniappan, L., Haddad, F. LIPPINCOTT WILLIAMS & WILKINS. 2020: 131

  View details for Web of Science ID 000590026300381

• Disaggregation of gastric cancer risk Between Asian American subgroups Huang, R. J., Hwang, J., Hsing, A., Palaniappan, L. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-PR03

  View details for Web of Science ID 000580647800524

• Regional disparities in gastric cancer survival in the United States: An observational cohort study of the Surveillance Epidemiology and End Results Program, 2004-2016 Huang, R., Hsing, A., Palaniappan, L., Hwang, J. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-C058

  View details for Web of Science ID 000580647800292

• Heterogeneity of Treatment and Outcomes Among Asians With Coronary Artery Disease in the United States. Journal of the American Heart Association Manjunath, L., Chung, S., Li, J., Shah, H., Palaniappan, L., Yong, C. M. 2020: e014362

  Abstract

  Background Prior data demonstrate significant heterogeneity regarding coronary artery disease risk factors and outcomes among Asians in the United States, but no studies have yet examined coronary artery disease treatment patterns or outcomes among disaggregated Asian American subgroups. Methods and Results From a total of 772882 patients with known race/ethnicity and sex who received care from a mixed-payer healthcare organization in Northern California between 2006 and 2015, a retrospective analysis was conducted on 6667 adults with coronary artery disease. Logistic regression was used to examine medical and procedural therapies and outcomes by race/ethnicity, with adjustment for age, sex, income, and baseline comorbidities. Compared with non-Hispanic whites, Chinese were more likely to undergo stenting (50.9% versus 60.8%, odds ratio [OR] 1.39 [95% CI, 1.04-1.87], p=0.005), whereas Filipinos were more likely to receive bypass surgery (6.9% versus 20.5%, OR 2.65 [95% CI, 1.75-4.01], P<0.0001). After stenting, Chinese, Filipinos, and Japanese were more likely than non-Hispanic whites to be prescribed clopidogrel (86.2%, 83.0%, and 91.4% versus 74.5%, ORs 1.86 [95% CI, 1.13-3.04], 1.86 [95% CI, 1.01-3.44], and 4.37 [95% CI, 1.02-18.67], respectively, P<0.0001). Lastly, Chinese and Asian Indians were more likely than non-Hispanic whites to be diagnosed with a myocardial infarction within 1year postangiography (15.6% and 17.4% versus 11.2%, ORs 1.49 [95% CI, 1.02-2.19] and 1.68 [95% CI, 1.21-2.34], respectively, P<0.0001). Conclusions Disaggregation of Asian Americans with coronary artery disease into individual racial/ethnic subgroups reveals significant variability in treatment patterns and outcomes. Further investigation into these differences may expose important opportunities to mitigate disparities and improve quality of care in this diverse population.

  View details for DOI 10.1161/JAHA.119.014362

  View details for PubMedID 32390539

• Implementation outcomes of humanwide: A pilot project of integrated precision health in team-based primary care Brown-Johnson, C., Safaeinili, N., Baratta, J., Morris, S., Palaniappan, L., Mahoney, M., Rosas, L., Winget, M. BMC. 2020

  View details for Web of Science ID 000533323500064

• County Rurality and Socioeconomic Deprivation is Associated with Reduced Survival from Gastric Cancer in the United States. Gastroenterology Huang, R. J., Shah, S. C., Camargo, M. C., Palaniappan, L., Hwang, J. H. 2020

  View details for DOI 10.1053/j.gastro.2020.05.006

  View details for PubMedID 32387539

• STATIN USE FOR SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN THE ELDERLY Spencer-Bonilla, G., Chung, S., Heidenreich, P. A., Palaniappan, L. P., Rodriguez, F. ELSEVIER SCIENCE INC. 2020: 1891

  View details for Web of Science ID 000522979101878

• Incremental value of diastolic stress test in identifying subclinical heart failure in patients with diabetes mellitus. European heart journal cardiovascular Imaging Nishi, T. n., Kobayashi, Y. n., Christle, J. W., Cauwenberghs, N. n., Boralkar, K. n., Moneghetti, K. n., Amsallem, M. n., Hedman, K. n., Contrepois, K. n., Myers, J. n., Mahaffey, K. W., Schnittger, I. n., Kuznetsova, T. n., Palaniappan, L. n., Haddad, F. n. 2020

  Abstract

  Resting echocardiography is a valuable method for detecting subclinical heart failure (HF) in patients with diabetes mellitus (DM). However, few studies have assessed the incremental value of diastolic stress for detecting subclinical HF in this population.Asymptomatic patients with Type 2 DM were prospectively enrolled. Subclinical HF was assessed using systolic dysfunction (left ventricular longitudinal strain <16% at rest and <19% after exercise in absolute value), abnormal cardiac morphology, or diastolic dysfunction (E/e' > 10). Metabolic equivalents (METs) were calculated using treadmill speed and grade, and functional capacity was assessed by percent-predicted METs (ppMETs). Among 161 patients studied (mean age of 59 ± 11 years and 57% male sex), subclinical HF was observed in 68% at rest and in 79% with exercise. Among characteristics, diastolic stress had the highest yield in improving detection of HF with 57% of abnormal cases after exercise and 45% at rest. Patients with revealed diastolic dysfunction during stress had significantly lower exercise capacity than patients with normal diastolic stress (7.3 ± 2.1 vs. 8.8 ± 2.5, P < 0.001 for peak METs and 91 ± 30% vs. 105 ± 30%, P = 0.04 for ppMETs). On multivariable modelling found that age (beta = -0.33), male sex (beta = 0.21), body mass index (beta = -0.49), and exercise E/e' >10 (beta = -0.17) were independently associated with peak METs (combined R2 = 0.46). A network correlation map revealed the connectivity of peak METs and diastolic properties as central features in patients with DM.Diastolic stress test improves the detection of subclinical HF in patients with diabetes mellitus.

  View details for DOI 10.1093/ehjci/jeaa070

  View details for PubMedID 32386203

• Machine learning and atherosclerotic cardiovascular disease risk prediction in a multi-ethnic population. NPJ digital medicine Ward, A., Sarraju, A., Chung, S., Li, J., Harrington, R., Heidenreich, P., Palaniappan, L., Scheinker, D., Rodriguez, F. 2020; 3 (1): 125

  Abstract

  The pooled cohort equations (PCE) predict atherosclerotic cardiovascular disease (ASCVD) risk in patients with characteristics within prespecified ranges and has uncertain performance among Asians or Hispanics. It is unknown if machine learning (ML) models can improve ASCVD risk prediction across broader diverse, real-world populations. We developed ML models for ASCVD risk prediction for multi-ethnic patients using an electronic health record (EHR) database from Northern California. Our cohort included patients aged 18 years or older with no prior CVD and not on statins at baseline (n = 262,923), stratified by PCE-eligible (n = 131,721) or PCE-ineligible patients based on missing or out-of-range variables. We trained ML models [logistic regression with L2 penalty and L1 lasso penalty, random forest, gradient boosting machine (GBM), extreme gradient boosting] and determined 5-year ASCVD risk prediction, including with and without incorporation of additional EHR variables, and in Asian and Hispanic subgroups. A total of 4309 patients had ASCVD events, with 2077 in PCE-ineligible patients. GBM performance in the full cohort, including PCE-ineligible patients (area under receiver-operating characteristic curve (AUC) 0.835, 95% confidence interval (CI): 0.825-0.846), was significantly better than that of the PCE in the PCE-eligible cohort (AUC 0.775, 95% CI: 0.755-0.794). Among patients aged 40-79, GBM performed similarly before (AUC 0.784, 95% CI: 0.759-0.808) and after (AUC 0.790, 95% CI: 0.765-0.814) incorporating additional EHR data. Overall, ML models achieved comparable or improved performance compared to the PCE while allowing risk discrimination in a larger group of patients including PCE-ineligible patients. EHR-trained ML models may help bridge important gaps in ASCVD risk prediction.

  View details for DOI 10.1038/s41746-020-00331-1

  View details for PubMedID 34552202

• Pharmacogenomics in Asian subpopulations and impacts on commonly prescribed medications. Clinical and translational science Lo, C. n., Nguyen, S. n., Yang, C. n., Witt, L. n., Wen, A. n., Liao, T. V., Nguyen, J. n., Lin, B. n., Altman, R. B., Palaniappan, L. n. 2020

  Abstract

  Asians as a group comprise of over 60% the world's population. There is an incredible amount of diversity in Asian and admixed populations that has not been studied in a pharmacogenetic context. The known pharmacogenetic differences in Asians subgroups generally represent previously known variants that are present at much lower or higher frequencies in Asians compared to other populations. This review aims to summarize the main drugs and known genes that appear to have differences in their pharmacogenetic properties in certain Asian populations. Evidence based guidelines and summary statistics from the Food and Drug Administration (FDA) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) were analyzed for ethnic differences in outcomes. Implicated drugs included commonly prescribed drugs such as warfarin, clopidogrel, carbamazepine, and allopurinol. The majority of these associations are due to Asians more commonly being CYP2C19 poor metabolizers and carriers of the HLA-B*15:02 allele. The relative risk increase seen ranged between genes and drugs but could be over 100x more likely in Asians such as the 172x increase in risk of SJS and TEN with carbamazepine use amongst HLA-B*15:02 carriers. The effects ranged from relatively benign reactions such as reduced drug efficacy to severe cutaneous skin reactions. These reactions are severe and prevalent enough to warrant pharmacogenetic testing and appropriate changes in dosing and medication choice for at risk populations. Further studies should be done on Asian cohorts to more fully understand pharmacogenetic variants in these populations to understand how such differences may influence drug response.

  View details for DOI 10.1111/cts.12771

  View details for PubMedID 32100936

• Variant Interpretation in Current Pharmacogenetic Testing. Journal of personalized medicine Luvsantseren, S. n., Whirl-Carrillo, M. n., Sangkuhl, K. n., Shin, N. n., Wen, A. n., Empey, P. n., Alam, B. n., David, S. n., Dunnenberger, H. M., Orlando, L. n., Altman, R. n., Palaniappan, L. n. 2020; 10 (4)

  Abstract

  In the current marketplace, there are now more than a dozen commercial companies providing pharmacogenetic tests. Each company varies in the panel of genes they test and the variants they are able to screen for. The reports generated by these companies provide phenotypic interpretations of pharmacogenes and clinically actionable gene-drug interactions based on internally curated data and proprietary algorithms. The freedom to choose the types of evidence to include versus exclude in interpreting genomics has created reporting discrepancies in the industry. The case report presented here reveals the discordant phenotype analysis provided by two pharmacogenetic testing companies. The uncertainty and unnecessary distress experienced by the patient highlights the need for consensus in phenotype reporting within the industry.

  View details for DOI 10.3390/jpm10040204

  View details for PubMedID 33142667

• One Size Does Not Fit All: Marked Heterogeneity in Incidence of and Survival from Gastric Cancer among Asian American Subgroups. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Huang, R. J., Sharp, N. n., Talamoa, R. O., Ji, H. P., Hwang, J. H., Palaniappan, L. P. 2020

  Abstract

  Asian Americans are at higher risk for non-cardia gastric cancers (NCGCs) relative to non-Hispanic Whites (NHWs). Asian Americans are genetically, linguistically, and culturally heterogeneous, yet have mostly been treated as a single population in prior studies. This aggregation may obscure important subgroup-specific cancer patterns.We utilized data from 13 regional United States cancer registries from 1990-2014 to determine secular trends in incidence and survivorship from NCGC. Data were analyzed for NHWs and the six largest Asian American subgroups: Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian (Indian/Pakistani).There exists substantial heterogeneity in NCGC incidence between Asian subgroups, with Koreans (48.6 per 100,000 person-years) having seven-fold higher age-adjusted incidence than South Asians (7.4 per 100,000 person-years). Asians had generally earlier stages of diagnosis and higher rates of surgical resection compared to NHWs. All Asian subgroups also demonstrated higher five-year observed survival compared to NHWs, with Koreans (41.3%) and South Asians (42.8%) having survival double that of NHWs (20.1%, p<0.001). In multivariable regression, differences in stage of diagnosis and rates of resection partially explained the difference in survivorship between Asian subgroups.We find substantial differences in incidence, staging, histology, treatment, and survivorship from NCGC between Asian subgroups, data which challenge our traditional perceptions about gastric cancer in Asians. Both biological heterogeneity and cultural/environmental differences may underlie these findings.These data are relevant to the national discourse regarding the appropriate role of gastric cancer screening, and identifies high-risk racial/ethnic subgroups who many benefit from customized risk attenuation programs.

  View details for DOI 10.1158/1055-9965.EPI-19-1482

  View details for PubMedID 32152216

• Machine learning and atherosclerotic cardiovascular disease risk prediction in a multi-ethnic population. NPJ digital medicine Ward, A. n., Sarraju, A. n., Chung, S. n., Li, J. n., Harrington, R. n., Heidenreich, P. n., Palaniappan, L. n., Scheinker, D. n., Rodriguez, F. n. 2020; 3: 125

  Abstract

  The pooled cohort equations (PCE) predict atherosclerotic cardiovascular disease (ASCVD) risk in patients with characteristics within prespecified ranges and has uncertain performance among Asians or Hispanics. It is unknown if machine learning (ML) models can improve ASCVD risk prediction across broader diverse, real-world populations. We developed ML models for ASCVD risk prediction for multi-ethnic patients using an electronic health record (EHR) database from Northern California. Our cohort included patients aged 18 years or older with no prior CVD and not on statins at baseline (n = 262,923), stratified by PCE-eligible (n = 131,721) or PCE-ineligible patients based on missing or out-of-range variables. We trained ML models [logistic regression with L2 penalty and L1 lasso penalty, random forest, gradient boosting machine (GBM), extreme gradient boosting] and determined 5-year ASCVD risk prediction, including with and without incorporation of additional EHR variables, and in Asian and Hispanic subgroups. A total of 4309 patients had ASCVD events, with 2077 in PCE-ineligible patients. GBM performance in the full cohort, including PCE-ineligible patients (area under receiver-operating characteristic curve (AUC) 0.835, 95% confidence interval (CI): 0.825-0.846), was significantly better than that of the PCE in the PCE-eligible cohort (AUC 0.775, 95% CI: 0.755-0.794). Among patients aged 40-79, GBM performed similarly before (AUC 0.784, 95% CI: 0.759-0.808) and after (AUC 0.790, 95% CI: 0.765-0.814) incorporating additional EHR data. Overall, ML models achieved comparable or improved performance compared to the PCE while allowing risk discrimination in a larger group of patients including PCE-ineligible patients. EHR-trained ML models may help bridge important gaps in ASCVD risk prediction.

  View details for DOI 10.1038/s41746-020-00331-1

  View details for PubMedID 33043149

  View details for PubMedCentralID PMC7511400

• The EffectiveNess of LIfestyle with Diet and Physical Activity Education ProGram Among Prehypertensives and Stage 1 HyperTENsives in an Urban Community Setting (ENLIGHTEN) Study. Journal of community health Gabiola, J., Morales, D., Quizon, O., Cadiz, R. I., Feliciano, K., Ruiz, R. L., Aguatis, C. J., Mararac, T., Rojina, J., Garcia, A., Hedlin, H., Cullen, M., Palaniappan, L. 2019

  Abstract

  This study aimsto determine the effectiveness of a monthly lifestyle education program, which included advice on nutritional changes and physical activity enhancement in the reduction of blood pressure and selected biochemical and anthropometric parameters among pre-hypertensive and stage 1 hypertensive participants in Manila, Philippines. Participants resided in two barangays (districts), in Manila, Philippines, and each barangay was assigned to either the intervention or attention-control group. The intervention group received monthly lectures on cardiovascular disease and organized classes on diet and exercise, while the attention-control group received monthly lectures on non-cardiovascular topics, with verbal advice that healthy diet and exercise are important. The primary outcome was systolic blood pressure, with secondary outcomes of BMI, waist circumference, and laboratory measures. Linear mixed effects models with an interaction between intervention group and time were used to estimate the 6-month change in each group. At 6months, systolic blood pressure was lower in the intervention group compared to the attention-control group (-12.7mmHg (95% CI [-14.5, -10.9]) vs. -0.24mmHg (95% CI [-1.87, 1.43]), p-value<0.001). Waist circumference (p<0.001), BMI (p<0.001), and total cholesterol (p=0.049) were also lower. However, no statistically significant difference in fasting glucose was observed between the two groups (p=0.740). This study showed that participants receiving a non-pharmacological intervention, specifically a low-cost diet and active lifestyle education program, experienced a greater decrease in blood pressure, BMI, waist circumference, and total cholesterol than the attention-control group. Educational programs such as in ENLIGHTEN show promise for a developing country with limited resources to improve hypertension levels, and ultimately cardiovascular health. ENLIGHTEN deserves further study in randomized trials.

  View details for DOI 10.1007/s10900-019-00764-0

  View details for PubMedID 31677046

• The Burden of Atherosclerotic Cardiovascular Disease in South Asians Residing in Canada: A Reflection From the South Asian Heart Alliance. CJC open Bainey, K. R., Gupta, M., Ali, I., Bangalore, S., Chiu, M., Kaila, K., Kaul, P., Khan, N., King-Shier, K. M., Palaniappan, L., Pare, G., Ramanathan, K., Ross, S., Shah, B. R. 2019; 1 (6): 271–81

  Abstract

  South Asians (SAs), originating from the Indian subcontinent (India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan), represent one quarter of the global population and are the largest visible minority in Canada. SAs experience the highest rates of coronary artery disease in Canada. Although conventional cardiovascular risk factors remain predictive in SA, the excess risk is not fully explained by these risk factors alone. Abdominal obesity, metabolic syndrome, and insulin resistance likely contribute a greater risk in SAs than in other populations. The South Asian Heart Alliance has been recently formed to investigate and recommend the best strategies for the prevention of cardiometabolic disease in SAs in Canada. This topic review represents a comprehensive overview of the magnitude of cardiovascular disease in SAs in Canada, with a review of conventional and novel risk markers in the SA population. Both primary and secondary prevention strategies are suggested and when possible, adapted specifically for the SA population. The need for SAs and their healthcare professionals to be more aware of the problem and potential solutions, along with the need for population-specific research, is highlighted.

  View details for DOI 10.1016/j.cjco.2019.09.004

  View details for PubMedID 32159121

• Does SLE widen or narrow race/ethnic disparities in the risk of five co-morbid conditions? Evidence from a community-based outpatient care system. Lupus Falasinnu, T., Chaichian, Y., Li, J., Chung, S., Waitzfelder, B. E., Fortmann, S. P., Palaniappan, L., Simard, J. F. 2019: 961203319884646

  Abstract

  OBJECTIVE: The heterogeneous spectrum of systemic lupus erythematosus (SLE) often presents with secondary complications such as cardiovascular disease (CVD), infections and neoplasms. Our study assessed whether the presence of SLE independently increases or reduces the disparities, accounting for the already higher risk of these outcomes among racial/ethnic minority groups without SLE.METHODS: We defined a cohort using electronic health records data (2005-2016) from a mixed-payer community-based outpatient setting in California serving patients of diverse racial/ethnic backgrounds. The eligible population included adult patients with SLE and matched non-SLE patients (≥18 years old). SLE was the primary exposure. The following outcomes were identified: pneumonia, other infections, CVD and neoplasms. For each racial/ethnic group, we calculated the proportion of incident co-morbidities by SLE exposure, followed by logistic regression for each outcome with SLE as the exposure. We evaluated interaction on the additive and multiplicative scales by calculating the relative excess risk due to interaction and estimating the cross-product term in each model.RESULTS: We identified 1036 SLE cases and 8875 controls. The incidence for all outcomes was higher among the SLE exposed. We found little difference in the odds of the outcomes associated with SLE across racial/ethnic groups, even after multivariable adjustment. This finding was consistent on the multiplicative and additive scales.CONCLUSION: We demonstrated that SLE status does not independently confer substantial interaction or heterogeneity by race/ethnicity toward the risk of pneumonia, other infections, CVD or neoplasms. Further studies in larger datasets are necessary to validate this novel finding.

  View details for DOI 10.1177/0961203319884646

  View details for PubMedID 31660790

• Variability in Gastric Cancer Survival by Disaggregated Asian American Subgroups Huang, R., Palaniappan, L., Hwang, J. LIPPINCOTT WILLIAMS & WILKINS. 2019: S689

  View details for Web of Science ID 000509756003036

• Disaggregation of Gastric Cancer Risk Between Asian American Subgroups Huang, R., Hwang, J., Palaniappan, L. LIPPINCOTT WILLIAMS & WILKINS. 2019: S688–S689

  View details for DOI 10.14309/01.ajg.0000594460.74476.13

  View details for Web of Science ID 000509756003035

• Characteristics of Academic Physicians Associated With Patient Satisfaction AMERICAN JOURNAL OF MEDICAL QUALITY Heidenreich, P., Shieh, L., Fassiotto, M., Kahn, J., Weinacker, A., Smith, R., Trockel, M., Shanafelt, T., Palaniappan, L. 2019: 1062860619876344

  View details for DOI 10.1177/1062860619876344

  View details for Web of Science ID 000488727200001

  View details for PubMedID 31529975

• Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States. Annals of internal medicine Sidney, S., Go, A. S., Rana, J. S. 2019; 171 (3): 225

  View details for DOI 10.7326/L19-0202

  View details for PubMedID 31382279

• South Asian Health. From Research to Practice and Policy: An Overview JOURNAL OF IMMIGRANT AND MINORITY HEALTH Gany, F., Palaniappan, L., Prasad, L., Acharya, S., Leng, J. 2019; 21: 3–6

  View details for DOI 10.1007/s10903-017-0552-1

  View details for Web of Science ID 000480465100002

• YEARS OF POTENTIAL LIFE LOST FROM CARDIOVASCULAR DISEASE AMONG HISPANICS ETHNICITY & DISEASE Manjunath, L., Hu, J., Palaniappan, L., Rodriguez, F. 2019; 29 (3): 477–84

  Abstract

  To quantify the impact of cardiovascular disease and its subtypes on the premature mortality of Hispanics in the United States.We used national death records to identify deaths for the three largest Hispanic subgroups (Mexicans, Puerto Ricans, and Cubans) in the United States from 2003 to 2012 (N = 832,550). We identified all deaths from cardiovascular disease and by subtype (ie, ischemic, cerebrovascular, hypertensive and heart failure) using the underlying cause of death via ICD-10 codes. Years of potential life lost (YPLL) was calculated by age categories standardizing with the 2000 US Census population. Population estimates were calculated using linear interpolation from 2000 and 2010 US Census data.After standardization, Puerto Ricans experienced the highest YPLL for all types of cardiovascular disease compared with Mexicans and Cubans (1,139 years per 100,000 compared with 868 and 841, respectively), a disparity that remained consistent over the course of a decade. Among different subcategories of cardiovascular disease, Puerto Ricans had the highest YPLL for ischemic and hypertensive heart disease, while Mexicans had the highest YPLL from cerebrovascular disease.In conclusion, disaggregation of Hispanic subgroups revealed marked heterogeneity in premature cardiovascular mortality. These findings suggest that measures to improve the cardiovascular health of Hispanics should incorporate subgroup status as a key part of public health strategy.

  View details for DOI 10.18865/ed.29.3.477

  View details for Web of Science ID 000476474900004

  View details for PubMedID 31367168

  View details for PubMedCentralID PMC6645724

• Comparison of Ideal Cardiovascular Health Attainment and Acculturation among Asian Americans and Latinos. Ethnicity & disease Rodriguez, F., Echeverría, S. E., Pentakota, S. R., Amadi, C., Hastings, K. G., Palaniappan, L. P. 2019; 29 (2): 287-296

  Abstract

  To determine the association between language and ideal cardiovascular health among Asian Americans and Latinos.Cross-sectional study using 2011-2016 National Health and Nutrition Examination Survey of Asian Americans (n=2,009) and Latinos (n=3,906).Participants were classified according to language spoken at home (only/mostly English spoken, both English and native language spoken equally, or mostly/only native language spoken).Ideal, intermediate and poor cardiovascular health status for smoking, blood pressure, glucose level, and total cholesterol.The majority of Asian Americans and Latinos had ideal smoking status, but those who only/mostly spoke English were more likely to smoke compared with those who spoke only/mostly spoke their native language. Approximately one third of Asian Americans and Latinos had intermediate (ie, borderline or treated to goal) levels of cardiovascular health for blood pressure, glucose level and total cholesterol. In adjusted models, those who spoke only/mostly their native language were significantly less likely to have poor smoking or hypertension status than those who spoke only/mostly English. Among Latinos, only/mostly Spanish speakers were more likely to have poor/ intermediate glucose levels (PR=1.35, 95% CI =1.21, 1.49) than those who spoke only/ mostly English, becoming statistically non-significant after adjusting for education and income.We found significant variation in ideal cardiovascular health attainment by language spoken at home in two of the largest immigrant groups in the United States. Findings suggest the need for language and culturally tailored public health and clinical initiatives to reduce cardiovascular risk in diverse populations.

  View details for DOI 10.18865/ed.29.2.287

  View details for PubMedID 31057314

  View details for PubMedCentralID PMC6478041

• Years of Potential Life Lost Because of Cardiovascular Disease in Asian-American Subgroups, 2003-2012. Journal of the American Heart Association Iyer, D. G., Shah, N. S., Hastings, K. G., Hu, J., Rodriguez, F., Boothroyd, D. B., Krishnan, A. V., Falasinnu, T., Palaniappan, L. 2019; 8 (7): e010744

  Abstract

  Background Asian-American subgroups (Asian-Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display varied cardiovascular disease mortality patterns, especially at younger ages. This study aims to examine the years of potential life lost because of ischemic heart disease and cerebrovascular disease among the 6 largest Asian-American subgroups compared with non-Hispanic whites. Methods and Results We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003 to 2012 to calculate race-specific life expectancy, mean years of potential life lost, and years of potential life lost per 100000 population for each Asian subgroup and non-Hispanic whites. Asian-American subgroups display heterogeneity in cardiovascular disease burden. Asian-Indians had a high burden of ischemic heart disease; Asian-Indian men lost 724years per 100000 population in 2012 and a mean of 17years to ischemic heart disease. Respectively, Vietnamese and Filipino men and women lost a mean of 17 and 16years of life to cerebrovascular disease; Filipino men lost 352years per 100000 population in 2012. All Asian subgroups for both sexes had higher years of life lost to cerebrovascular disease compared with non-Hispanic whites. Conclusions Cardiovascular disease burden varies among Asian subgroups, and contributes to greater premature mortality in certain subgroups. Asian-Indian and Filipino populations have the highest years of life lost because of ischemic heart disease and Filipino and Vietnamese have the highest years of life lost because of cerebrovascular disease. Analysis of risk factors and development of subgroup-specific interventions are required to address these health disparities.

  View details for PubMedID 30890022

• Years of Potential Life Lost Because of Cardiovascular Disease in Asian-American Subgroups, 2003-2012 JOURNAL OF THE AMERICAN HEART ASSOCIATION Iyer, D. G., Shah, N. S., Hastings, K. G., Hu, J., Rodriguez, F., Boothroyd, D. B., Krishnan, A. V., Falasinnu, T., Palaniappan, L. 2019; 8 (7)

  View details for DOI 10.1161/JAHA.118.010744

  View details for Web of Science ID 000484574300007

• COMPARISON OF IDEAL CARDIOVASCULAR HEALTH ATTAINMENT AND ACCULTURATION AMONG ASIAN AMERICANS AND LATINOS ETHNICITY & DISEASE Rodriguez, F., Echeverria, S. E., Pentakota, S., Amadi, C., Hastings, K. G., Palaniappan, L. P. 2019; 29 (2): 287–96

  View details for DOI 10.18865/ed.29.2.287

  View details for Web of Science ID 000465200600008

• STRONG-D: Strength training regimen for normal weight diabetics: Rationale and design CONTEMPORARY CLINICAL TRIALS Faroqi, L., Bonde, S., Goni, D., Wong, C., Wong, M., Walai, K., Araya, S., Azamey, S., Schreiner, G., Bandy, M., Raghuram, S., Mittal, A., Mukherji, A., Wangdak, T., Talamoa, R., Vera, K., Nacif-Coelho, C., Groppo, L., Christensen, M., Johannsen, N., Haddad, F., Moharir, M., Palaniappan, L. 2019; 78: 101–6

  View details for DOI 10.1016/j.cct.2019.01.005

  View details for Web of Science ID 000461403500011

• Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians JAMA NETWORK OPEN Garcia, L. C., Chung, S., Liao, L., Altamirano, J., Fassiotto, M., Maldonado, B., Heidenreich, P., Palaniappan, L. 2019; 2 (2)

  View details for DOI 10.1001/jamanetworkopen.2019.0027

  View details for Web of Science ID 000465423800022

• Diabetes-attributable mortality in the United States from 2003 to 2016 using a multiple-cause-of-death approach DIABETES RESEARCH AND CLINICAL PRACTICE Rodriguez, F., Blum, M. R., Falasinnu, T., Hastings, K. G., Hu, J., Cullen, M. R., Palaniappan, L. P. 2019; 148: 169–78

  View details for DOI 10.1016/j.diabres.2019.01.015

  View details for Web of Science ID 000458859200019

• Diabetes-Attributable Mortality in the United States from 2003-2016 Using a Multiple-Cause-of-Death Approach. Diabetes research and clinical practice Rodriguez, F., Blum, M. R., Falasinnu, T., Hastings, K. G., Hu, J., Cullen, M. R., Palaniappan, L. P. 2019

  Abstract

  AIMS: Deaths attributable to diabetes may be underestimated using an underlying cause of death (COD) approach in U.S. death records. This study sought to characterize the burden of diabetes deaths using a multiple-cause of death approach and to identify temporal changes in co-reported causes of death among those with diabetes listed anywhere on their death records.METHODS: COD were identified using data from the National Center for Health Statistics from 2003-2016. We calculated age-adjusted mortality rates for diabetes as the underlying or contributing COD by race/ethnicity. We used ICD-10 codes to identify leading causes of death among those with and without diabetes on their death records. We compared temporal changes in deaths due to cardiovascular disease, cerebrovascular disease, cancer, and other causes.RESULTS: The study population included 34,313,964 decedents aged ≥25 from 2003-2016. Diabetes was listed as an underlying COD in approximately 3.0% (n=1,031,000) and 6.7% (n=2,295,510) of the death records, respectively. Decedents with diabetes listed as an underlying COD experienced a 16% decline in mortality, and the race/ethnicity-specific average annual percentage changes (AAPC) showed significant declining trends for most groups (AAPC ranged from 0.18 to -2.83%). Cardiovascular disease remained the leading underlying COD among diabetes-attributable deaths, although its proportion of deaths fell from 31 to 27% over time. Co-reported COD diversified, and were more likely to include hypertension and hypertensive renal disease among those with diabetes on their death records.CONCLUSIONS: Our findings underscore the importance of using a multiple-cause-of-death approach for more completely characterizing diabetes' contribution to mortality.

  View details for PubMedID 30641162

• STRONG-D: Strength training regimen for normal weight diabetics: Rationale and design. Contemporary clinical trials Faroqi, L., Bonde, S., Goni, D. T., Wong, C. W., Wong, M., Walai, K., Araya, S., Azamey, S., Schreiner, G., Bandy, M., Raghuram, S. S., Mittal, A., Mukherji, A., Wangdak, T., Talamoa, R., Vera, K., Nacif-Coelho, C., Cde, L. G., Christensen, M., Johannsen, N., Haddad, F., Moharir, M., Palaniappan, L. 2019

  Abstract

  BACKGROUND: Currently, there is a lack of data on effective lifestyle recommendations for normal-weight diabetics (NWD), who can represent up to 1 in 5 individuals with Type II Diabetes Mellitus (T2DM). NWD is especially prevalent in Asian populations and the elderly. Specific exercise treatment recommendations are needed for patients with normal-weight diabetes (NWD), as those in this category face higher mortality rates than overweight and obese diabetics. Standard T2DM treatment recommends aerobic training; however, performing aerobic training alone may not be appropriate for NWD and strength training may be a more effective treatment recommendation.OBJECTIVE: While it is known that strength and aerobic training are beneficial in obese diabetics, there is currently insufficient evidence to recommend this regimen in NWD. The Strength Training Regimen for Normal Weight Diabetics (STRONG-D) study aims to determine the best exercise regimen for NWD and address the current lack of appropriate physical activity recommendations for this population. The primary goal of this study is to determine whether strength training aids glycemic control better than aerobic training in NWD.STUDY DESIGN: STRONG-D is a three-arm randomized controlled trial designed to compare the clinical effectiveness of structured strength training only, aerobic training only, and combination (strength + aerobic) training sessions, modeled after the intervention in the Health Benefits of Aerobic and Resistance Training in T2DM patients (HART-D) study. Potential participants meeting eligibility criteria of HbA1c values of 6.5% to 13.0% and BMI of 18.5 kg/m2 to 25 kg/m2 will be enrolled. After randomization, participants will begin a 9-month exercise intervention. The primary outcomes will be HbA1c levels. The secondary endpoints will include physical fitness, body composition measured by Dual X-Ray Absorptiometry (DXA) scans, and leg strength and endurance measured by Biodex testing. Initial follow-up visits will occur at 3 months, 6 months, and 9 months. To determine the long-term effects of the exercise intervention, passive follow-up will continue via electronic health records (EHR) until a 24-month follow-up visit. A total of 282 participants will be randomized into the three study arms determine the clinically significant differences between strength-only, aerobic-only and combination regimens.

  View details for PubMedID 30625372

• Atherosclerotic Cardiovascular Disease Risk Prediction in Disaggregated Asian and Hispanic Subgroups Using Electronic Health Records. Journal of the American Heart Association Rodriguez, F. n., Chung, S. n., Blum, M. R., Coulet, A. n., Basu, S. n., Palaniappan, L. P. 2019; 8 (14): e011874

  Abstract

  Background Risk assessment is the cornerstone for atherosclerotic cardiovascular disease ( ASCVD ) treatment decisions. The Pooled Cohort Equations ( PCE ) have not been validated in disaggregated Asian or Hispanic populations, who have heterogeneous cardiovascular risk and outcomes. Methods and Results We used electronic health record data from adults aged 40 to 79 years from a community-based, outpatient healthcare system in northern California between January 1, 2006 and December 31, 2015, without ASCVD and not on statins. We examined the calibration and discrimination of the PCE and recalibrated the equations for disaggregated race/ethnic subgroups. The cohort included 231 622 adults with a mean age of 53.1 (SD 9.7) years and 54.3% women. There were 56 130 Asian (Chinese, Asian Indian, Filipino, Japanese, Vietnamese, and other Asian) and 19 760 Hispanic (Mexican, Puerto Rican, and other Hispanic) patients. There were 2703 events (332 and 189 in Asian and Hispanic patients, respectively) during an average of 3.9 (SD 1.5) years of follow-up. The PCE overestimated risk for NHW s, African Americans, Asians, and Hispanics by 20% to 60%. The extent of overestimation of ASCVD risk varied by disaggregated racial/ethnic subgroups, with a predicted-to-observed ratio of ASCVD events ranging from 1.1 for Puerto Rican patients to 1.9 for Chinese patients. The PCE had adequate discrimination, although it varied significantly by race/ethnic subgroups (C-indices 0.66-0.83). Recalibration of the PCE did not significantly improve its performance. Conclusions Using electronic health record data from a large, real-world population, we found that the PCE generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups.

  View details for DOI 10.1161/JAHA.118.011874

  View details for PubMedID 31291803

• Creating Fair Models of Atherosclerotic Cardiovascular Disease Pfohl, S., Marafino, B., Coulet, A., Rodriguez, F., Palaniappan, L., Shah, N. H., Assoc Comp Machinery ASSOC COMPUTING MACHINERY. 2019: 271–78

  View details for DOI 10.1145/3306618.3314278

  View details for Web of Science ID 000556121100038

• Years of Life Lost Due to Cardiovascular Disease Among Asian American Subgroups, 2003-2012 Iyer, D., Palaniappan, L. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for DOI 10.1161/circ.139.suppl_1.P127

  View details for Web of Science ID 000478079000078

• Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States. Annals of internal medicine Hastings, K. G., Kapphahn, K. n., Boothroyd, D. B., Rehkopf, D. H., Cullen, M. R., Palaniappan, L. n. 2019; 171 (3): 225

  View details for DOI 10.7326/L19-0203

  View details for PubMedID 31382280

• Disaggregating Hispanic American cancer mortality burden by detailed ethnicity. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Zamora, S. M., Pinheiro, P. S., Gomez, S. L., Hastings, K. G., Palaniappan, L. P., Hu, J. n., Thompson, C. A. 2019

  Abstract

  Hispanics are the largest minority population in the United States (18%). They represent a heterogeneous and growing population. Cancer is the leading cause of death among Hispanics, yet few studies have described cancer mortality burden by specific Hispanic group nationwide.Cancer-related deaths from U.S. death certificates for the years 2003-2012 were analyzed for decedents identifying as Mexican, Puerto Rican, Cuban, and Central or South American. We calculated descriptive statistics including potential years of lives lost (PYLL), age-adjusted rates, standardized mortality ratios, and fitted JoinPoint regression models to evaluate annual trends by Hispanic group, using non-Hispanic Whites (NHWs) as the reference population.We identified 287,218 cancer deaths among Hispanics and 4,570,559 among NHWs. Mortality trends were heterogeneous across Hispanic groups. Female NHWs and male Puerto Ricans had the greatest rates of adjusted PYLL per 1000 (NHWs, 19.6; Puerto Ricans, 16.5). Liver cancer was ranked among the top 5 cancer-related deaths for every Hispanic group, but not for NHWs. Stomach cancer mortality was twice as high for most Hispanic groups when compared to NHWs and especially high for Mexicans (male SMR, 2.07; 95% CI, 2.01-2.13; female SMR, 2.62; 95% CI, 2.53-2.71) Conclusion: We observed marked heterogeneity in cancer mortality across Hispanic groups. Several cancers affect Hispanics disproportionately compared to NHWs. Screening programs in Hispanics should be considered for stomach and liver cancer.Disaggregated analysis of Hispanics is needed to fully understand cancer burden among the diverse Hispanic population and is critical for cancer prevention and control efforts.

  View details for DOI 10.1158/1055-9965.EPI-18-0872

  View details for PubMedID 31147314

• Cardiometabolic-Renal Disease in South Asians: Consensus Recommendations from the Cardio Renal Society of America CARDIORENAL MEDICINE Vijayaraghavan, K., McCullough, P. A., Singh, B., Gupta, M., Enas, E., Mohan, V., Misra, A., Deedwania, P., Brinton, E. A., Vijayaraghavan, K., McCullough, P., Singh, B., Neff, J., Rausch, J., Petrides, S., Katsulis, Y., Ivie, J., Deedwania, P., Gupta, M., Nanda, N. C., Enas, E., Mohan, V., Joshi, S., Misra, A., Brinton, E. A., Mudaliar, S., Kanaya, A. M., Palaniappan, L., Rao, G., Zaman, J., Kerkar, P., Ganda, O., Fonseca, V., Pergola, P., Tumlin, J., Nigwekar, S., Varma, N., Packham, D., Phatarpekar, A., Wong, N., Gupta, R., Malik, S., Contractor, A., Soman, S., Chadha, N., Consensus Panel Steering Comm 2019; 9 (4): 240–51

  Abstract

  Rates of cardiometabolic-renal disease are extremely high among South Asians (India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives, and Nepal) residing in their home countries and worldwide. The Cardio Renal Society of America, National Kidney Foundation of Arizona, and Twinepidemic Inc. convened a task force to examine evidence and reach consensus regarding cardiometabolic-renal disease prevention in South Asians. The task force distilled the findings from 5 years of face-to-face and virtual meetings addressing questions derived from expert reviews of published data using the Delphi technique to create these consensus statements.Several high-quality observational studies document the high and increasing incidence and prevalence of cardiometabolic-renal disease among South Asians, starting well before adulthood, owing to genetic, cultural, and environmental factors. Despite the need for additional prospective studies, especially randomized trials, of educational, screening, and other prevention efforts, sufficient information is already available to expand and intensify ongoing efforts in professional and lay education to help control this epidemic. The task force proposes to provide this expansion over the next 10 years through scientific and lay publications and other educational programs to promote more effective action among the public, health care professionals, payers, and regulators in screening for and treating cardiometabolic-renal risk factors and preventing disease in South Asians, starting at an early age. Key Messages: These consensus statements describe risk factors and prognoses characteristic of South Asians regarding cardiometabolic-renal diseases, to aid physician decision-making, health care system delivery, and research initiatives to improve the quality of care for South Asians worldwide.

  View details for DOI 10.1159/000499341

  View details for Web of Science ID 000474231200005

  View details for PubMedID 31079117

• Unraveling Race, Socioeconomic Factors, and Geographical Context in the Heterogeneity of Lupus Mortality in the United States. ACR open rheumatology Falasinnu, T. n., Chaichian, Y. n., Palaniappan, L. n., Simard, J. F. 2019; 1 (3): 164–72

  Abstract

  Systemic lupus erythematosus (SLE) is a chronic autoimmune disease disproportionately affecting women and racial/ethnic minorities. We examined SLE-related mortality over time to assess whether the impact of race is attenuated when social economic status (SES) and geographic context are also considered.This study examined whether social environment attenuates racial disparities in SLE-related mortality using race-geographical combinations of the US population known as the "Eight Americas." This framework jointly characterizes race, SES, and geographical location in relation to health disparities in the United States. Using National Vital Statistics and US Census data, we estimated mortality parameters for each of the Eight Americas.We identified 24 773 SLE deaths (2003-2014). Average annual mortality rates were highest among blacks in three race-geographical contexts: average-income blacks, southern low-income blacks, and high-risk urban blacks (14 to 15 deaths per million population) and lowest among nonblacks living in average-income settings (3 to 4 deaths per million population). Age at death was lowest (~47.5 years) for blacks and Asians and highest among low-income rural whites (~64.8 years).Blacks sharing the same social and geographical contexts as whites were disproportionately more likely to die young. Although blacks inhabited three vastly different contexts, SLE-related mortality parameters did not vary among socially advantaged and disadvantaged blacks. These findings suggest that race may transcend SES and geographical parameters as a key determinant of SLE-related mortality.

  View details for DOI 10.1002/acr2.1024

  View details for PubMedID 31777791

  View details for PubMedCentralID PMC6858029

• Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians. JAMA network open Garcia, L. C., Chung, S. n., Liao, L. n., Altamirano, J. n., Fassiotto, M. n., Maldonado, B. n., Heidenreich, P. n., Palaniappan, L. n. 2019; 2 (2): e190027

  Abstract

  Patient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients.To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians.This population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018.Physician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken.The highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey.Of the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity.This study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.

  View details for PubMedID 30794297

• Estimating Personal Resting Heart Rate from Wearable Biosensor Data Jiang, C., Faroqi, L., Palaniappan, L., Dunn, J., IEEE IEEE. 2019

  View details for Web of Science ID 000508002200062

• Socioeconomic Differences in the Epidemiologic Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States, 2003 to 2015 An Observational Study ANNALS OF INTERNAL MEDICINE Hastings, K. G., Boothroyd, D. B., Kapphahn, K., Hu, J., Rehkopf, D. H., Cullen, M. R., Palaniappan, L. 2018; 169 (12): 836-+

  View details for DOI 10.7326/M17-0796

  View details for Web of Science ID 000454061700015

• Reviewing the role of healthy volunteer studies in drug development JOURNAL OF TRANSLATIONAL MEDICINE Karakunnel, J. J., Bui, N., Palaniappan, L., Schmidt, K. T., Mahaffey, K. W., Morrison, B., Figg, W. D., Kummar, S. 2018; 16

  View details for DOI 10.1186/s12967-018-1710-5

  View details for Web of Science ID 000452069700001

• Reviewing the role of healthy volunteer studies in drug development. Journal of translational medicine Karakunnel, J. J., Bui, N., Palaniappan, L., Schmidt, K. T., Mahaffey, K. W., Morrison, B., Figg, W. D., Kummar, S. 2018; 16 (1): 336

  Abstract

  BACKGROUND: With the exception of genotoxic oncology drugs, first-in-human, Phase 1 clinical studies of investigational drugs have traditionally been conducted in healthy volunteers (HVs). The primary goal of these studies is to investigate the pharmacokinetics and pharmacodynamics of a novel drug candidate, determine appropriate dosing, and document safety and tolerability.MAIN BODY: When tailored to specific study objectives, HV studies are beneficial to manufacturers and patients alike and can be applied to both non-oncology and oncology drug development. Enrollment of HVs not only increases study accrual rates for dose-escalation studies but also alleviates the ethical concern of enrolling patients with disease in a short-term study at subtherapeutic doses when other studies (e.g. Phase 2 or Phase 3 studies) may be more appropriate for the patient. The use of HVs in non-oncology Phase 1 clinical trials is relatively safe but nonetheless poses ethical challenges because of the potential risks to which HVs are exposed. In general, most adverse events associated with non-oncology drugs are mild in severity, and serious adverse events are rare, but examples of severe toxicity have been reported. The use of HVs in the clinical development of oncology drugs is more limited but is nonetheless useful for evaluating clinical pharmacology and establishing an appropriate starting dose for studies in cancer patients. During the development of oncology drugs, clinical pharmacology studies in HVs have been used to assess pharmacokinetics, drug metabolism, food effects, potential drug-drug interactions, effects of hepatic and renal impairment, and other pharmacologic parameters vital for clinical decision-making in oncology. Studies in HVs are also being used to evaluate biosimilars versus established anticancer biologic agents.CONCLUSION: A thorough assessment of toxicity and pharmacology throughout the drug development process is critical to ensure the safety of HVs. With the appropriate safeguards, HVs will continue to play an important role in future drug development.

  View details for PubMedID 30509294

• Racial/ethnic differences in reporting versus rating of healthcare experiences. Medicine Chung, S., Mujal, G., Liang, L., Palaniappan, L. P., Frosch, D. L. 2018; 97 (50): e13604

  Abstract

  Asians are reported to have poorer healthcare experience than non-Hispanic Whites (NHWs), but the sources of the differences are not understood. One explanation is Asian's reluctance to choose extreme responses in survey. We thus sought to compare NHW-Asian differences in responses to healthcare experience surveys when asked to report versus rate their experiences. Patients of an outpatient care system in 2013 to 2014 in the United States were studied. Patient experience surveys were sent after randomly selected clinic visits. Responses from 6 major Asian subgroups and NHWs were included (N = 61,115). The surveys used a combined questionnaire of Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Press Ganey surveys. CG-CAHPS questions are framed as "reporting" and Press Ganey questions as "rating" of experiences. We compared the proportion of favorable (or top box) responses to 2 related questions, one from CG-CAHPS and another from Press Ganey, and assessed racial/ethnic differences when using each of the 2 related questions, using a Pearson chi-squared test for independence. All Asian subgroups were less likely to select top box than NHWs for all questions. The Asian-NHW differences in 'rating" questions were larger than the difference in related "reporting" questions. Of those who chose top box to CG-CAHPS questions (e.g., "Yes" on a question asking "Waited < 15 minutes"), their responses to related Press Ganey questions varied widely: 47% to 57% of Asian subgroups versus 67% of NHWs rated wait time as "Very good." The extent of racial/ethnic differences in patient-reported experiences varies based on how questions are framed. The observed poorer experiences by Asians are in part explained by their worse rating of similar objectively measurable experiences.

  View details for PubMedID 30558033

• South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology JOURNAL OF COMMUNITY HEALTH Palaniappan, L., Garg, A., Enas, E., Lewis, H., Bari, S., Gulati, M., Flores, C., Mathur, A., Molina, C., Narula, J., Rahman, S., Leng, J., Gany, F. 2018; 43 (6): 1100–1114

  View details for DOI 10.1007/s10900-018-0527-8

  View details for Web of Science ID 000450787000012

• Public health and health systems: implications for the prevention and management of type 2 diabetes in south Asia LANCET DIABETES & ENDOCRINOLOGY Hills, A. P., Misra, A., Gill, J. R., Byrne, N. M., Soares, M. J., Ramachandran, A., Palaniappan, L., Street, S. J., Jayawardena, R., Khunti, K., Arena, R. 2018; 6 (12): 992–1002

  View details for DOI 10.1016/S2213-8587(18)30203-1

  View details for Web of Science ID 000450920800015

• Racial/ethnic differences in reporting versus rating of healthcare experiences MEDICINE Chung, S., Mujal, G., Liang, L., Palaniappan, L. P., Frosch, D. L. 2018; 97 (50)

  View details for DOI 10.1097/MD.0000000000013604

  View details for Web of Science ID 000456326400073

• Socioeconomic Differences in the Epidemiologic Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States, 2003 to 2015: An Observational Study. Annals of internal medicine Hastings, K. G., Boothroyd, D. B., Kapphahn, K., Hu, J., Rehkopf, D. H., Cullen, M. R., Palaniappan, L. 2018

  Abstract

  Background: Recent data suggest that the United States is in the midst of an epidemiologic transition in the leading cause of death.Objective: To examine county-level sociodemographic differences in the transition from heart disease to cancer as the leading cause of death in the United States.Design: Observational study.Setting: U.S. death records, 2003 to 2015.Participants: Decedents aged 25 years or older, classified by racial/ethnic group.Measurements: All-cause, heart disease, and cancer mortality stratified by quintiles of county median household income. Age- and sex-adjusted mortality rates and average annual percentage of change were calculated.Results: Heart disease was the leading cause of death in 79% of counties in 2003 and 59% in 2015. Cancer was the leading cause of death in 21% of counties in 2003 and 41% in 2015. The shift to cancer as the leading cause of death was greatest in the highest-income counties. Overall, heart disease mortality rates decreased by 28% (30% in high-income counties vs. 22% in low-income counties) from 2003 to 2015, and cancer mortality rates decreased by 16% (18% in high-income counties vs. 11% in low-income counties). In the lowest-income counties, heart disease remained the leading cause of death among all racial/ethnic groups, and improvements were smaller for both heart disease and cancer.Limitation: Use of county median household income as a proxy for socioeconomic status.Conclusion: Data show that heart disease is more likely to be the leading cause of death in low-income counties. Low-income counties have not experienced the same decrease in mortality rates as high-income counties, which suggests a later transition to cancer as the leading cause of death in low-income counties.Primary Funding Source: National Institute on Minority Health and Health Disparities.

  View details for PubMedID 30422275

• Prevalence, Treatment, and Outcomes Among Asian Subgroups With Coronary Artery Disease Manjunath, L., Chung, S., Li Jiang, Palaniappan, L., Yong, C. M. LIPPINCOTT WILLIAMS & WILKINS. 2018

  View details for Web of Science ID 000528619407029

• Evaluating the clinical implementation of structured exercise: A randomized controlled trial among non-insulin dependent type II diabetics CONTEMPORARY CLINICAL TRIALS Faroqi, L., Wong, M., Bonde, S., Wong, C., Walai, K., West, W., Goni, D., Araya, S., Azamey, S., Nacif-Coelho, C., Raghuram, S., Vera, K., Mittal, A., Groppo, L., Christensen, M., Johannsen, N., Haddad, F., Moharir, M., Palaniappan, L. 2018; 74: 25–31

  View details for DOI 10.1016/j.cct.2018.09.003

  View details for Web of Science ID 000449893200004

• County-Level Hispanic Ethnic Density and Cardiovascular Disease Mortality JOURNAL OF THE AMERICAN HEART ASSOCIATION Rodriguez, F., Hu, J., Kershaw, K., Hastings, K. G., Lopez, L., Cullen, M. R., Harrington, R. A., Palaniappan, L. P. 2018; 7 (19)

  View details for DOI 10.1161/JAHA.118.009107

  View details for Web of Science ID 000452823000013

• County-Level Hispanic Ethnic Density and Cardiovascular Disease Mortality. Journal of the American Heart Association Rodriguez, F., Hu, J., Kershaw, K., Hastings, K. G., Lopez, L., Cullen, M. R., Harrington, R. A., Palaniappan, L. P. 2018; 7 (19): e009107

  Abstract

  Background Hispanics are the fastest growing ethnic group in the United States, and little is known about how Hispanic ethnic population density impacts cardiovascular disease ( CVD ) mortality. Methods and Results We examined county-level deaths for Hispanics and non-Hispanic whites from 2003 to 2012 using data from the National Center for Health Statistics' Multiple Cause of Death mortality files. Counties with more than 20 Hispanic deaths (n=715) were included in the analyses. CVD deaths were identified using International Classification of Diseases, Tenth Revision (ICD-10), I00 to I78, and population estimates were calculated using linear interpolation from 2000 and 2010 census data. Multivariate linear regression was used to examine the association of Hispanic ethnic density with Hispanic and non-Hispanic white age-adjusted CVD mortality rates. County-level age-adjusted CVD mortality rates were adjusted for county-level demographic, socioeconomic, and healthcare factors. There were a total of 4769040 deaths among Hispanics (n=382416) and non-Hispanic whites (n=4386624). Overall, cardiovascular age-adjusted mortality rates were higher among non-Hispanic whites compared with Hispanics (244.8 versus 189.0 per 100000). Hispanic density ranged from 1% to 96% in each county. Counties in the highest compared with lowest category of Hispanic density had 60% higher Hispanic mortality (215.3 versus 134.2 per 100000 population). In linear regression models, after adjusting for county-level demographic, socioeconomic, and healthcare factors, increasing Hispanic ethnic density remained strongly associated with mortality for Hispanics but not for non-Hispanic whites. Conclusions CVD mortality is higher in counties with higher Hispanic ethnic density. County-level characteristics do not fully explain the higher CVD mortality among Hispanics in ethnically concentrated counties.

  View details for PubMedID 30371295

• Public health and health systems: implications for the prevention and management of type 2 diabetes in south Asia. The lancet. Diabetes & endocrinology Hills, A. P., Misra, A., Gill, J. M., Byrne, N. M., Soares, M. J., Ramachandran, A., Palaniappan, L., Street, S. J., Jayawardena, R., Khunti, K., Arena, R. 2018

  Abstract

  Many non-communicable chronic diseases, including type 2 diabetes, are highly prevalent, costly, and largely preventable. The prevention and management of type 2 diabetes in south Asia requires a combination of lifestyle changes and long-term health-care management. However, public health and health-care systems in south Asian countries face serious challenges, including the need to provide services to many people with inadequate resources, and substantial between-population and within-population inequalities. In this Series paper, we explore the importance and particular challenges of public health and health systems in south Asian countries (Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka) with respect to the provision of culturally appropriate lifestyle modification to prevent and manage diabetes, especially in resource-poor settings. Effective primary prevention strategies are urgently needed to counter risk factors and behaviours preconception, in utero, in infancy, and during childhood and adolescence. A concerted focus on education, training, and capacity building at the community level would ensure the more widespread use of non-physician care, including community health workers. Major investment from governments and other sources will be essential to achieve substantial improvements in the prevention and management of type 2 diabetes in the region.

  View details for PubMedID 30287104

• Patient and provider perspectives on the development of personalized medicine: a mixed-methods approach JOURNAL OF COMMUNITY GENETICS Puryear, L., Downs, N., Nevedal, A., Lewis, E. T., Ormond, K. E., Bregendahl, M., Suarez, C. J., David, S. P., Charlap, S., Chu, I., Asch, S. M., Pakdaman, N., Chang, S., Cullen, M. R., Palaniappan, L. 2018; 9 (3): 283–91

  View details for DOI 10.1007/s12687-017-0349-x

  View details for Web of Science ID 000435437400011

• South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. Journal of community health Palaniappan, L., Garg, A., Enas, E., Lewis, H., Bari, S., Gulati, M., Flores, C., Mathur, A., Molina, C., Narula, J., Rahman, S., Leng, J., Gany, F. 2018

  Abstract

  South Asians (SAs) are at heightened risk for cardiovascular disease as compared to other ethnic groups, facing premature and more severe coronary artery disease, and decreased insulin sensitivity. This disease burden can only be partially explained by conventional risk factors, suggesting the need for a specific cardiovascular risk profile for SAs. Current research, as explored through a comprehensive literature review, suggests the existence of population specific genetic risk factors such as lipoprotein(a), as well as population specific gene modulating factors. This review catalogues the available research on cardiovascular disease and genetics, anthropometry, and pathophysiology, and cancer genetics among SAs, with a geographical focus on the U.S. A tailored risk profile will hinge upon population customized classification and treatment guidelines, informed by continued research.

  View details for PubMedID 29948525

• Development of an intervention for the prevention of type 2 diabetes addressing the specific needs of South Asian-origin population living in the Netherlands: a pilot study Beune, E., van Valkengoed, I., Muilwijk, M., Kumar, B., Diaz, E., Gill, J., Palaniappan, L., Davidson, E. OXFORD UNIV PRESS. 2018: 178

  View details for Web of Science ID 000432430700517

• Clinical and Personal Utility of Genetic Risk Testing AMERICAN FAMILY PHYSICIAN David, S. P., Palaniappan, L. 2018; 97 (9): 600–602

  View details for PubMedID 29763257

• Heart Disease and Stroke Statistics-2018 Update A Report From the American Heart Association CIRCULATION Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., de Ferranti, S. D., Ferguson, J. F., Fornage, M., Gillespie, C., Isasi, C. R., Jimenez, M. C., Jordan, L., Judd, S. E., Lackland, D., Lichtman, J. H., Lisabeth, L., Liu, S., Longenecker, C. T., Lutsey, P. L., Mackey, J. S., Matchar, D. B., Matsushita, K., Mussolino, M. E., Nasir, K., O'Flaherty, M., Palaniappan, L. P., Pandey, A., Pandey, D. K., Reeves, M. J., Ritchey, M. D., Rodriguez, C. J., Roth, G. A., Rosamond, W. D., Sampson, U. A., Satou, G. M., Shah, S. H., Spartano, N. L., Tirschwell, D. L., Tsao, C. W., Voeks, J. H., Willey, J. Z., Wilkins, J. T., Wu, J. Y., Alger, H. M., Wong, S. S., Muntner, P., Amer Heart Assoc Council Epidemi 2018; 137 (12): E67–E492

  View details for DOI 10.1161/CIR.0000000000000558

  View details for Web of Science ID 000428027400001

  View details for PubMedID 29386200

• AMultiple-Imputation "Forward Bridging" Approach to Address Changes in the Classification of Asian Race/Ethnicity on the US Death Certificate AMERICAN JOURNAL OF EPIDEMIOLOGY Thompson, C. A., Boothroyd, D. B., Hastings, K. G., Cullen, M. R., Palaniappan, L. P., Rehkopf, D. H. 2018; 187 (2): 347–57

  Abstract

  The incomparability of old and new classification systems for describing the same data can be seen as a missing-data problem, and, under certain assumptions, multiple imputation may be used to "bridge" 2 classification systems. One example of such a change is the introduction of detailed Asian-American race/ethnicity classifications on the 2003 version of the US national death certificate, which was adopted for use by 38 states between 2003 and 2011. Using county- and decedent-level data from 3 different national sources for pre- and postadoption years, we fitted within-state multiple-imputation models to impute ethnicities for decedents classified as "other Asian" during preadoption years. We present mortality rates derived using 3 different methods of calculation: 1) including all states but ignoring the gradual adoption of the new death certificate over time, 2) including only the 7 states with complete reporting of all ethnicities, and 3) including all states and applying multiple imputation. Estimates from our imputation model were consistently in the middle of the other 2 estimates, and trend results demonstrated that the year-by-year estimates of the imputation model were more similar to those of the 7-state model. This work demonstrates how multiple imputation can provide a "forward bridging" approach to make more accurate estimates over time in newly categorized populations.

  View details for PubMedID 29401361

  View details for PubMedCentralID PMC5860289

• Type 2 Diabetes Mellitus in South Asian Americans BIOPSYCHOSOCIAL APPROACHES TO UNDERSTANDING HEALTH IN SOUTH ASIAN AMERICANS Khan, S., Shah, N., Parikh, N., Iyer, D., Palaniappan, L., Perera, M. J., Chang, E. C. 2018: 121–47

  View details for DOI 10.1007/978-3-319-91120-5_7

  View details for Web of Science ID 000463883000008

• Thyroid cancer mortality is higher in Filipinos in the United States: An analysis using national mortality records from 2003 through 2012 CANCER Nguyen, M. T., Hu, J., Hastings, K. G., Daza, E. J., Cullen, M. R., Orloff, L. A., Palaniappan, L. P. 2017; 123 (24): 4860–67

  View details for DOI 10.1002/cncr.30925

  View details for Web of Science ID 000417078600017

• Thyroid cancer mortality is higher in Filipinos in the United States: An analysis using national mortality records from 2003 through 2012. Cancer Nguyen, M. T., Hu, J., Hastings, K. G., Daza, E. J., Cullen, M. R., Orloff, L. A., Palaniappan, L. P. 2017; 123 (24): 4860-4867

  Abstract

  Well-differentiated thyroid carcinoma has a favorable prognosis, but patients with multiple recurrences have drastically lower survival. Filipinos in the United States are known to have high rates of thyroid cancer incidence and disease recurrence. To the authors' knowledge, it is unknown whether Filipinos also have higher thyroid cancer mortality rates.The authors studied thyroid cancer mortality in Filipino, non-Filipino Asian (NFA), and non-Hispanic white (NHW) adults using US death records (2003-2012) and US Census data. Age-adjusted mortality rates and proportional mortality ratios (PMRs) were calculated. Sex, nativity status, age at death, and educational attainment also were examined.The authors examined 19,940,952 deaths. The age-adjusted mortality rates due to thyroid cancer were highest in Filipinos (1.72 deaths per 100,000 population; 95% confidence interval [95% CI], 1.51-1.95) compared with NFAs (1.03 per 100,000 population; 95% CI, 0.95-1.12) and NHWs (1.17 per 100,000 population; 95% CI, 1.16-1.18). Compared with NHWs, higher proportionate mortality was observed in Filipino women (3-5 times higher) across all age groups, and among Filipino men, the PMR was 2 to 3 times higher in the subgroup aged >55 years. Filipinos who completed a higher educational level had a notably higher PMR (5.0) compared with their counterparts who had not (3.5).Negative prognostic factors for thyroid cancer traditionally include age >45 years and male sex. The results of the current study demonstrate that Filipinos die of thyroid cancer at higher rates than NFA and NHW individuals of similar ages. Highly educated Filipinos and Filipino women may be especially at risk of poor thyroid cancer outcomes. Filipino ethnicity should be factored into clinical decision making in the management of patients with thyroid cancer. Cancer 2017;123:4860-7. © 2017 American Cancer Society.

  View details for DOI 10.1002/cncr.30958

  View details for PubMedID 28881423

  View details for PubMedCentralID PMC5716919

• Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults JOURNAL OF THE AMERICAN HEART ASSOCIATION Rodriguez, F., Hastings, K. G., Hu, J., Lopez, L., Cullen, M., Harrington, R. A., Palaniappan, L. P. 2017; 6 (12)

  View details for DOI 10.1161/JAHA.117.007207

  View details for Web of Science ID 000418951100050

• Cardiovascular Health in African Americans A Scientific Statement From the American Heart Association CIRCULATION Carnethon, M. R., Pu, J., Howard, G., Albert, M. A., Anderson, C. M., Bertoni, A. G., Mujahid, M. S., Palaniappan, L., Taylor, H. A., Willis, M., Yancy, C. W., Amer Heart Assoc Council Epidemiol, Council Cardiovasc Dis Young, Council Cardiovasc Stroke Nursing, Council Clinical Cardiology, Council Functional Genomics Transl, Stroke Council 2017; 136 (21): E393–E423

  Abstract

  Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management.The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention.The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment.The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.

  View details for DOI 10.1161/CIR.0000000000000534

  View details for Web of Science ID 000415712900001

  View details for PubMedID 29061565

• Unraveling Race and Social Context in Understanding Disparities in Lupus Mortality in the United States Falasinnu, T., Chaichian, Y., Palaniappan, L., Simard, J. F. WILEY. 2017

  View details for Web of Science ID 000411824101112

• Geographic Variations in Cardiovascular Disease Mortality Among Asian American Subgroups, 2003-2011 JOURNAL OF THE AMERICAN HEART ASSOCIATION Pu, J., Hastings, K. G., Boothroyd, D., Jose, P. O., Chung, S., Shah, J. B., Cullen, M. R., Palaniappan, L. P., Rehkopf, D. H. 2017; 6 (7)

  Abstract

  There are well-documented geographical differences in cardiovascular disease (CVD) mortality for non-Hispanic whites. However, it remains unknown whether similar geographical variation in CVD mortality exists for Asian American subgroups. This study aims to examine geographical differences in CVD mortality among Asian American subgroups living in the United States and whether they are consistent with geographical differences observed among non-Hispanic whites.Using US death records from 2003 to 2011 (n=3 897 040 CVD deaths), age-adjusted CVD mortality rates per 100 000 population and age-adjusted mortality rate ratios were calculated for the 6 largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and compared with non-Hispanic whites. There were consistently lower mortality rates for all Asian American subgroups compared with non-Hispanic whites across divisions for CVD mortality and ischemic heart disease mortality. However, cerebrovascular disease mortality demonstrated substantial geographical differences by Asian American subgroup. There were a number of regional divisions where certain Asian American subgroups (Filipino and Japanese men, Korean and Vietnamese men and women) possessed no mortality advantage compared with non-Hispanic whites. The most striking geographical variation was with Filipino men (age-adjusted mortality rate ratio=1.18; 95% CI, 1.14-1.24) and Japanese men (age-adjusted mortality rate ratio=1.05; 95% CI: 1.00-1.11) in the Pacific division who had significantly higher cerebrovascular mortality than non-Hispanic whites.There was substantial geographical variation in Asian American subgroup mortality for cerebrovascular disease when compared with non-Hispanic whites. It deserves increased attention to prioritize prevention and treatment in the Pacific division where approximately 80% of Filipinos CVD deaths and 90% of Japanese CVD deaths occur in the United States.

  View details for PubMedID 28701306

• NATIVITY STATUS AND CARDIOVASCULAR DISEASE MORTALITY AMONG HISPANICS Rodriguez, F., Hastings, K., Hu, J., Harrington, R., Palaniappan, L. ELSEVIER SCIENCE INC. 2017: 1753

  View details for Web of Science ID 000397342302475

• South Asian Health. From Research to Practice and Policy: An Overview. Journal of immigrant and minority health Gany, F., Palaniappan, L., Prasad, L., Acharya, S., Leng, J. 2017

  Abstract

  The US South Asian population has grown tremendously, and is now over 2.5 million. South Asians often face tremendous cultural, socioeconomic, linguistic and structural obstacles to good health, and face staggering cardiovascular disease (CVD) and cancer risk. Coupled with this is a paucity of detailed data on the population's unique CVD and cancer risk profiles, etiologic mechanisms, and effective interventions to address South Asian health disparities. This data gap compelled an initiative to develop more targeted research and evidence-based practice and policy approaches. The South Asian Health Initiative (SAHI), a community based participatory research partnership between the Immigrant Health and Cancer Disparities Center at Memorial Sloan Kettering Cancer and the South Asian Council for Social Services (SACSS), and the Palo Alto Medical Foundation Research Institute thus partnered to effect the first national South Asian translational research endeavor, South Asian Health: From Research to Practice and Policy, summarized in this paper.

  View details for DOI 10.1007/s10903-017-0552-1

  View details for PubMedID 28285333

• Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., de Ferranti, S. D., Floyd, J., Fornage, M., Gillespie, C., Isasi, C. R., Jiménez, M. C., Jordan, L. C., Judd, S. E., Lackland, D., Lichtman, J. H., Lisabeth, L., Liu, S., Longenecker, C. T., Mackey, R. H., Matsushita, K., Mozaffarian, D., Mussolino, M. E., Nasir, K., Neumar, R. W., Palaniappan, L., Pandey, D. K., Thiagarajan, R. R., Reeves, M. J., Ritchey, M., Rodriguez, C. J., Roth, G. A., Rosamond, W. D., Sasson, C., Towfighi, A., Tsao, C. W., Turner, M. B., Virani, S. S., Voeks, J. H., Willey, J. Z., Wilkins, J. T., Wu, J. H., Alger, H. M., Wong, S. S., Muntner, P. 2017; 135 (10): e146-e603

  View details for DOI 10.1161/CIR.0000000000000485

  View details for PubMedID 28122885

  View details for PubMedCentralID PMC5408160

• Social and clinically-relevant cardiovascular risk factors in Asian Americans adults: NHANES 2011-2014. Preventive medicine Echeverria, S. E., Mustafa, M., Pentakota, S. R., Kim, S., Hastings, K., Amadi, C., Palaniappan, L. 2017

  Abstract

  Little evidence exists examining cardiovascular risk factors among Asian Americans and how social determinants such as nativity status and education pattern risk in the United States (U.S.) context. We used the National Health and Nutrition Examination Survey, which purposely oversampled Asian Americans from 2011 to 2014, and examined prevalence of Type II diabetes, smoking and obesity for Asian Americans (n=1363) and non-Latino Whites (n=4121). We classified Asian Americans as U.S. or foreign-born and by years in the U.S. Obesity status was based on standard body mass index (BMI) cut points of ≥30kg/m(2) and Asian-specific cut points (BMI≥25kg/m(2)) that may be more clinically relevant for this population. We fit separate logistic regression models for each outcome using complex survey design methods and tested for the joint effect of race, nativity and education on each outcome. Diabetes and obesity prevalence (applying Asian-specific BMI cut points) were higher among Asian Americans when compared to non-Latino Whites but smoking prevalence was lower. These patterns remained in fully adjusted models and showed small increases with longer duration in the U.S. Joint effects models showed higher odds of prevalent Type II diabetes and obesity (Asian-specific) for foreign-born Asians, regardless of years in the U.S. and slightly higher risk for low education, when compared to non-Latino Whites with high education. Smoking models showed significant interaction effects between race and education for non-Latino Whites only. Our study supports the premise that social as well as clinical factors should be considered when developing health initiatives for Asian Americans.

  View details for DOI 10.1016/j.ypmed.2017.02.016

  View details for PubMedID 28219784

• Cardiovascular Disease Risk Score: Results from the Filipino-American Women Cardiovascular Study. Journal of racial and ethnic health disparities Ancheta, I. B., Battie, C. A., Volgman, A. S., Ancheta, C. V., Palaniappan, L. 2017; 4 (1): 25-34

  Abstract

  Although cardiovascular disease (CVD) is a leading cause of morbidity and mortality of Filipino-Americans, conventional CVD risk calculators may not be accurate for this population. CVD risk scores of a group of Filipino-American women (FAW) were measured using the major risk calculators. Secondly, the sensitivity of the various calculators to obesity was determined.This is a cross-sectional descriptive study that enrolled 40-65-year-old FAW (n = 236), during a community-based health screening study. Ten-year CVD risk was calculated using the Framingham Risk Score (FRS), Reynolds Risk Score (RRS), and Atherosclerotic Cardiovascular Disease (ASCVD) calculators. The 30-year risk FRS and the lifetime ASCVD calculators were also determined.Levels of predicted CVD risk varied as a function of the calculator. The 10-year ASCVD calculator classified 12 % of participants with ≥10 % risk, but the 10-year FRS and RRS calculators classified all participants with ≤10 % risk. The 30-year "Hard" Lipid and BMI FRS calculators classified 32 and 43 % of participants with high (≥20 %) risk, respectively, while 95 % of participants were classified with ≥20 % risk by the lifetime ASCVD calculator. The percent of participants with elevated CVD risk increased as a function of waist circumference for most risk score calculators.Differences in risk score as a function of the risk score calculator indicate the need for outcome studies in this population. Increased waist circumference was associated with increased CVD risk scores underscoring the need for obesity control as a primary prevention of CVD in FAW.

  View details for DOI 10.1007/s40615-015-0196-6

  View details for PubMedID 27294770

• Disaggregation of Cause-Specific Cardiovascular Disease Mortality Among Hispanic Subgroups. JAMA cardiology Rodriguez, F., Hastings, K. G., Boothroyd, D. B., Echeverria, S., Lopez, L., Cullen, M., Harrington, R. A., Palaniappan, L. P. 2017

  Abstract

  Hispanics are the largest minority group in the United States and face a disproportionate burden of risk factors for cardiovascular disease (CVD) and low socioeconomic position. However, Hispanics paradoxically experience lower all-cause mortality rates compared with their non-Hispanic white (NHW) counterparts. This phenomenon has been largely observed in Mexicans, and whether this holds true for other Hispanic subgroups or whether these favorable trends persist over time remains unknown.To disaggregate a decade of national CVD mortality data for the 3 largest US Hispanic subgroups.Deaths from CVD for the 3 largest US Hispanic subgroups-Mexicans, Puerto Ricans, and Cubans-compared with NHWs were extracted from the US National Center for Health Statistics mortality records using the underlying cause of death based on coding from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (I00-II69). Mortality data were evaluated from January 1, 2003, to December 31, 2012. Population estimates were calculated using linear interpolation from the 2000 and 2010 US Census reports. Data were analyzed from November 2015 to July 2016.Mortality due to CVD.Participants included 688 074 Mexican, 163 335 Puerto Rican, 130 397 Cuban, and 19 357 160 NHW individuals (49.0% men and 51.0% women; mean [SD] age, 75 [15] years). At the time of CVD death, Mexicans (age, 67 [18] years) and Puerto Ricans (age, 68 [17] years) were younger compared with NHWs (age, 76 [15] years). Mortality rates due to CVD decreased from a mean of 414.2 per 100 000 in 2003 to 303.3 per 100 000 in 2012. Estimated decreases in mortality rate for CVD from 2003 to 2012 ranged from 85 per 100 000 for all Hispanic women to 144 per 100 000 for Cuban men, but rate differences between groups vary substantially, with Puerto Ricans exhibiting similar mortality patterns to NHWs, and Mexicans experiencing lower mortality. Puerto Ricans experienced higher mortality rates for ischemic and hypertensive heart disease compared with other subgroups, whereas Mexicans experienced higher rates of cerebrovascular disease deaths.Significant differences in CVD mortality rates and changes over time were found among the 3 largest Hispanic subgroups in the United States. Findings suggest that the current aggregate classification of Hispanics masks heterogeneity in CVD mortality reporting, leading to an incomplete understanding of health risks and outcomes in this population.

  View details for DOI 10.1001/jamacardio.2016.4653

  View details for PubMedID 28114655

• Thyroid cancer mortality higher in Filipinos in United States: an analysis using national mortality records from 2003-2012. Cancer Nguyen, M., Hu, J., Hastings, K., Daza, E., Cullen, M., Orloff, L., Palaniappan, L. 2017

  View details for DOI 10.1002/cncr.30958

• Can Secure Patient-Provider Messaging Improve Diabetes Care? Diabetes care Chung, S. n., Panattoni, L. n., Chi, J. n., Palaniappan, L. n. 2017; 40 (10): 1342–48

  Abstract

  Internet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on how messaging is associated with use and clinical quality measures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management.Patients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011-2014 were studied (N= 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering.Most patients (72%) used messaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA1ctarget of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patient-initiated messages.Patients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice.

  View details for PubMedID 28807977

• Health Risk Assessments, Family Health History, and Predictive Genetic/Pharmacogenetic Testing GENOMIC AND PRECISION MEDICINE: PRIMARY CARE, 3RD EDITION Bregendahl, M., Orlando, L. A., Palaniappan, L., David, S. P. 2017: 75–88

  View details for DOI 10.1016/B978-0-12-800685-6.00003-5

  View details for Web of Science ID 000417838100006

• Patient and provider perspectives on the development of personalized medicine: a mixed-methods approach. Journal of community genetics Puryear, L. n., Downs, N. n., Nevedal, A. n., Lewis, E. T., Ormond, K. E., Bregendahl, M. n., Suarez, C. J., David, S. P., Charlap, S. n., Chu, I. n., Asch, S. M., Pakdaman, N. n., Chang, S. I., Cullen, M. R., Palaniappan, L. n. 2017

  Abstract

  While genetic testing gains adoption in specialty services such as oncology, neurology, and cardiology, use of genetic and genomic testing has yet to be adopted as widely in primary care. The purpose of this study is to identify and compare patient and primary care provider (PCP) expectations of genetics services in primary care. Patient and PCP perspectives were assessed through a mixed-method approach combining an online survey and semi-structured interviews in a primary care department of a large academic medical institution. A convenience sample of 100 adult primary care patients and 26 PCPs was gathered. The survey and interview questions focused on perceptions of genetic testing, experience with genetic testing, and expectations of genetic services in primary care. Patients felt that their PCP was knowledgeable about genetic testing and expected their PCP to be the first to recognize a need for genetic testing based on family history. Nonetheless, patients reported that PCPs rarely used family history information to discuss genetic risks or order testing. In contrast, PCPs felt uncertain about the clinical utility and scientific value of genetic testing. PCPs were concerned that genetic testing could cause anxiety, frustration, discrimination, and reduced insurability, and that there was unequal access to testing. PCPs described themselves as being "gatekeepers" to genetic testing but did not feel confident or have the desire to become experts in genetic testing. However, PCPs were open to increasing their working knowledge of genetic testing. Within this academic medical center, there is a gap between what patients expect and what primary care providers feel they are adequately prepared to provide in terms of genetic testing services.

  View details for PubMedID 29280052

• Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults. Journal of the American Heart Association Rodriguez, F. n., Hastings, K. G., Hu, J. n., Lopez, L. n., Cullen, M. n., Harrington, R. A., Palaniappan, L. P. 2017; 6 (12)

  Abstract

  Hispanic persons represent a heterogeneous and growing population of any race with origins in Mexico, the Caribbean, Central America, South America, or other Spanish-speaking countries. Previous studies have documented variation in cardiovascular risk and outcomes among Hispanic subgroups. Few studies have investigated whether these patterns vary by nativity status among Hispanic subgroups.We used the National Center for Health Statistics mortality file to compare deaths of Hispanic (n=1 258 229) and non-Hispanic white (n=18 149 774) adults (aged ≥25 years) from 2003 to 2012. We identified all deaths related to cardiovascular disease (CVD) and categorized them by subtype (all CVD, ischemic, or cerebrovascular) using the underlying cause of death (International Classification of Diseases, 10th Revision codes I00-I78, I20-I25, and I60-I69, respectively). Population estimates were calculated using linear interpolation from the 2000 and 2010 US censuses. CVD accounted for 31% of all deaths among Hispanic adults. Race/ethnicity and nativity status were recorded on death certificates by the funeral director using state guidelines. Nativity status was defined as foreign versus US born; 58% of Hispanic decedents were foreign born. Overall, Hispanic adults had lower age-adjusted CVD mortality rates than non-Hispanic white adults (296 versus 385 per 100 000). Foreign-born Cubans, Mexicans, and Puerto Ricans had higher CVD mortality than their US-born counterparts (rate ratio: 2.64 [95% confidence interval, 2.46-2.81], 1.17 [95% confidence interval, 1.15-1.21], and 1.91 [95% confidence interval, 1.83-1.99], respectively).Mortality rates for total cardiovascular, ischemic, and cerebrovascular disease are higher among foreign- than US-born Hispanic adults. These findings suggest the importance of disaggregating CVD mortality by disease subtype, Hispanic subgroup, and nativity status.

  View details for PubMedID 29237590

• Comparison of body mass index, waist circumference, and waist to height ratio in the prediction of hypertension and diabetes mellitus: Filipino-American women cardiovascular study. Preventive medicine reports Battie, C. A., Borja-Hart, N., Ancheta, I. B., Flores, R., Rao, G., Palaniappan, L. 2016; 4: 608-613

  Abstract

  The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and the validity of using Asian-specific thresholds of these indices were examined in Filipino-American women (FAW). Filipino-American women (n = 382), 40-65 years of age were screened for hypertension (HTN) and diabetes (DM) in four major US cities. Body mass index (BMI), waist circumference (WC) and waist circumference to height ratio (WHtR) were measured. ROC analyses determined that the three obesity measurements were similar in predicting HTN and DM (AUC: 0.6-0.7). The universal WC threshold of ≥ 35 in. missed 13% of the hypertensive patients and 12% of the diabetic patients. The Asian WC threshold of ≥ 31.5 in. increased detection of HTN and DM but with a high rate of false positives. The traditional BMI ≥ 25 kg/m(2) threshold missed 35% of those with hypertension and 24% of those with diabetes. The Asian BMI threshold improved detection but resulted in a high rate of false positives. The suggested WHtR cut-off of ≥ 0.5 missed only 1% of those with HTN and 0% of those with DM. The three obesity measurements had similar but modest ability to predict HTN and DM in FAW. Using Asian-specific thresholds increased accuracy but with a high rate of false positives. Whether FAW, especially at older ages, should be encouraged to reach these lower thresholds needs further investigation because of the high false positive rates.

  View details for PubMedID 27882291

• Cross-national comparisons of increasing suicidal mortality rates for Koreans in the Republic of Korea and Korean Americans in the USA, 2003-2012. Epidemiology and psychiatric sciences Kung, A., Hastings, K. G., Kapphahn, K. I., Wang, E. J., Cullen, M. R., Ivey, S. L., Palaniappan, L. P., Chung, S. 2016: 1-12

  Abstract

  Korea has the highest suicide rate of developed countries, two times higher than the USA. Suicide trends among Koreans Americans living in the USA during the same period have not yet been described. We report suicide mortality rates and trends for four groups: (1) Korean Americans, (2) non-Hispanic White (NHW) Americans, (3) selected Asian American subgroups and (4) Koreans living in the Republic of Korea.We used US national (n = 18 113 585) and World Health Organization (WHO) (n = 232 919 253) mortality records for Korea from 2003 to 2012 to calculate suicide rates, all expressed per 100 000 persons. We assessed temporal trends and differences in age, gender and race/ethnicity using binomial regression.Suicide rates are highest in Koreans living in the Republic of Korea (32.4 for men and 14.8 for women). Suicide rates in Korean Americans (13.9 for men and 6.5 for women) have nearly doubled from 2003 to 2012 and exceed rates for all other Asian American subgroups (5.4-10.7 for men and 1.6-4.2 for women). Suicide rates among NHWs (21.0 for men and 5.6 for women) remain high. Among elders, suicide in Korean Americans (32.9 for men and 15.4 for women) is the highest of all examined racial/ethnic groups in the USA.Suicide in Korean Americans is higher than for other Asian Americans and follows temporal patterns more similar to Korea than the USA. Interventions to prevent suicide in Korean American populations, particularly among the elderly, are needed.

  View details for PubMedID 27830639

• Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011. BMJ open Hastings, K. G., Eggleston, K., Boothroyd, D., Kapphahn, K. I., Cullen, M. R., Barry, M., Palaniappan, L. P. 2016; 6 (10)

  Abstract

  With immigration and minority populations rapidly growing in the USA, it is critical to assess how these populations fare after immigration, and in subsequent generations. Our aim is to compare death rates and cause of death across foreign-born, US-born and country of origin Chinese and Japanese populations.We analysed all-cause and cause-specific age-standardised mortality rates and trends using 2003-2011 US death record data for Chinese and Japanese decedents aged 25 or older by nativity status and sex, and used the WHO Mortality Database for Hong Kong and Japan decedents in the same years. Characteristics such as age at death, absolute number of deaths by cause and educational attainment were also reported.We examined a total of 10 458 849 deaths. All-cause mortality was highest in Hong Kong and Japan, intermediate for foreign-born, and lowest for US-born decedents. Improved mortality outcomes and higher educational attainment among foreign-born were observed compared with developed Asia counterparts. Lower rates in US-born decedents were due to decreased cancer and communicable disease mortality rates in the US heart disease mortality was either similar or slightly higher among Chinese-Americans and Japanese-Americans compared with those in developed Asia counterparts.Mortality advantages in the USA were largely due to improvements in cancer and communicable disease mortality outcomes. Mortality advantages and higher educational attainments for foreign-born populations compared with developed Asia counterparts may suggest selective migration. Findings add to our limited understanding of the racial and environmental contributions to immigrant health disparities.

  View details for DOI 10.1136/bmjopen-2016-012201

  View details for PubMedID 27793837

  View details for PubMedCentralID PMC5093623

• The Burden of Cancer in Asian Americans: A Report of National Mortality Trends by Asian Ethnicity CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Thompson, C. A., Gomez, S. L., Hastings, K. G., Kapphahn, K., Yu, P., Shariff-Marco, S., Bhatt, A. S., Wakelee, H. A., Patel, M. I., Cullen, M. R., Palaniappan, L. P. 2016; 25 (10): 1371-1382

  Abstract

  Asian Americans (AA) are the fastest growing U.S. population, and when properly distinguished by their ethnic origins, exhibit substantial heterogeneity in socioeconomic status, health behaviors, and health outcomes. Cancer is the second leading cause of death in the United States, yet trends and current patterns in the mortality burden of cancer among AA ethnic groups have not been documented.We report age-adjusted rates, standardized mortality ratios, and modeled trends in cancer-related mortality in the following AA ethnicities: Asian Indians, Chinese, Filipinos, Japanese, Koreans, and Vietnamese, from 2003 to 2011, with non-Hispanic whites (NHW) as the reference population.For most cancer sites, AAs had lower cancer mortality than NHWs; however, mortality patterns were heterogeneous across AA ethnicities. Stomach and liver cancer mortality was very high, particularly among Chinese, Koreans, and Vietnamese, for whom these two cancer types combined accounted for 15% to 25% of cancer deaths, but less than 5% of cancer deaths in NHWs. In AA women, lung cancer was a leading cause of death, but (unlike males and NHW females) rates did not decline over the study period.Ethnicity-specific analyses are critical to understanding the national burden of cancer among the heterogeneous AA population.Our findings highlight the need for disaggregated reporting of cancer statistics in AAs and warrant consideration of tailored screening programs for liver and gastric cancers. Cancer Epidemiol Biomarkers Prev; 25(10); 1371-82. ©2016 AACR.

  View details for DOI 10.1158/1055-9965.EPI-16-0167

  View details for PubMedID 27694108

• First Trimester Hemoglobin A1c Prediction of Gestational Diabetes. American journal of perinatology Osmundson, S. S., Zhao, B. S., Kunz, L., Wang, E., Popat, R., Nimbal, V. C., Palaniappan, L. P. 2016; 33 (10): 977-982

  Abstract

  Objective The objective of this study is to examine whether a first trimester hemoglobin A1c (A1C) of 5.7 to 6.4% predicts an abnormal second trimester oral glucose tolerance test (OGTT). Methods We conducted a retrospective cohort study of all women screened with A1C through 13 (6/7) weeks' gestation between January 1, 2011, and December 31, 2012. Prediabetic women (A1C of 5.7-6.4%) were compared with women with a normal first trimester A1C (< 5.7%). The primary outcome was an abnormal 2-hour, 75-g OGTT as defined by the International Association of Diabetes and Pregnancy Study Groups. Results There were 2,812 women who met inclusion criteria of whom 6.7% (n = 189) were prediabetic. Women with prediabetes were more likely to have gestational diabetes mellitus (GDM) even after adjusting for potential confounders (29.1 vs. 13.7%; adjusted relative risk, 1.48; 95% confidence interval, 1.15-1.89). There were no statistically significant differences in secondary outcomes except that women with prediabetes had less excessive gestational weight gain. A prediabetic-range A1C in the first trimester was associated with a 13% sensitivity and a 94% specificity for predicting GDM Conclusion Although women with prediabetes by first trimester A1C are significantly more likely to have GDM, the low sensitivity of an A1C in this range renders it a poor test to identify women who will develop GDM.

  View details for DOI 10.1055/s-0036-1581055

  View details for PubMedID 27120479

• Toward clinical genomics in everyday medicine: perspectives and recommendations. Expert review of molecular diagnostics Delaney, S. K., Hultner, M. L., Jacob, H. J., Ledbetter, D. H., McCarthy, J. J., Ball, M., Beckman, K. B., Belmont, J. W., Bloss, C. S., Christman, M. F., Cosgrove, A., Damiani, S. A., Danis, T., Delledonne, M., Dougherty, M. J., Dudley, J. T., Faucett, W. A., Friedman, J. R., Haase, D. H., Hays, T. S., Heilsberg, S., Huber, J., Kaminsky, L., Ledbetter, N., Lee, W. H., Levin, E., Libiger, O., Linderman, M., Love, R. L., Magnus, D. C., Martland, A., McClure, S. L., Megill, S. E., Messier, H., Nussbaum, R. L., Palaniappan, L., Patay, B. A., Popovich, B. W., Quackenbush, J., Savant, M. J., Su, M. M., Terry, S. F., Tucker, S., Wong, W. T., Green, R. C. 2016; 16 (5): 521-532

  Abstract

  Precision or personalized medicine through clinical genome and exome sequencing has been described by some as a revolution that could transform healthcare delivery, yet it is currently used in only a small fraction of patients, principally for the diagnosis of suspected Mendelian conditions and for targeting cancer treatments. Given the burden of illness in our society, it is of interest to ask how clinical genome and exome sequencing can be constructively integrated more broadly into the routine practice of medicine for the betterment of public health. In November 2014, 46 experts from academia, industry, policy and patient advocacy gathered in a conference sponsored by Illumina, Inc. to discuss this question, share viewpoints and propose recommendations. This perspective summarizes that work and identifies some of the obstacles and opportunities that must be considered in translating advances in genomics more widely into the practice of medicine.

  View details for DOI 10.1586/14737159.2016.1146593

  View details for PubMedID 26810587

• Dyslipidemia in Special Ethnic Populations. Endocrinology and metabolism clinics of North America Pu, J., Romanelli, R., Zhao, B., Azar, K. M., Hastings, K. G., Nimbal, V., Fortmann, S. P., Palaniappan, L. P. 2016; 45 (1): 205-216

  Abstract

  This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.

  View details for DOI 10.1016/j.ecl.2015.09.013

  View details for PubMedID 26893006

• Clocks Moving at Different Speeds Cultural Variation in the Satisfaction With Wait Time for Outpatient Care MEDICAL CARE Chung, S., Johns, N., Zhao, B., Romanelli, R., Pu, J., Palaniappan, L. P., Luft, H. 2016; 54 (3): 269-276

  Abstract

  To explore racial/ethnic differences in satisfaction with wait time of scheduled office visits by comparing electronic health record (EHR)-based, patient-reported, and patient satisfaction with wait time: A large multispecialty ambulatory care organization in Northern California. Patient experience surveys were collected between 2010 and 2014. Surveys were mailed after randomly selected nonurgent visits. Returned survey data were linked to EHR data for surveyed visits.Observational, retrospective study designed to assess differences in patient-reported wait time, wait-time satisfaction, and actual EHR-recorded wait time with respect to self-reported race/ethnicity. Multivariate regression models with provider random effects were used to evaluate differences.Asian subgroups (Chinese, Asian Indian, Filipino, Japanese, Korean, and Vietnamese) and Latinos gave poorer ratings for wait time than non-Hispanic whites (NHWs). The average wait time reported by Asians was longer than that reported by NHWs. On the basis of EHR data, however, no minority group was likely to wait longer, and all, except for Japanese (10%), were more likely to be late for the appointment (16%: Filipino and 23%: Asian Indian), than NHWs (13%).Given actual wait times, Asians perceive longer wait time and were less satisfied with wait times. Asians may have different expectations about wait time at the clinic.

  View details for DOI 10.1097/MLR.0000000000000473

  View details for Web of Science ID 000372935400008

• Clocks Moving at Different Speeds: Cultural Variation in the Satisfaction With Wait Time for Outpatient Care. Medical care Chung, S., Johns, N., Zhao, B., Romanelli, R., Pu, J., Palaniappan, L. P., Luft, H. 2016; 54 (3): 269-276

  Abstract

  To explore racial/ethnic differences in satisfaction with wait time of scheduled office visits by comparing electronic health record (EHR)-based, patient-reported, and patient satisfaction with wait time: A large multispecialty ambulatory care organization in Northern California. Patient experience surveys were collected between 2010 and 2014. Surveys were mailed after randomly selected nonurgent visits. Returned survey data were linked to EHR data for surveyed visits.Observational, retrospective study designed to assess differences in patient-reported wait time, wait-time satisfaction, and actual EHR-recorded wait time with respect to self-reported race/ethnicity. Multivariate regression models with provider random effects were used to evaluate differences.Asian subgroups (Chinese, Asian Indian, Filipino, Japanese, Korean, and Vietnamese) and Latinos gave poorer ratings for wait time than non-Hispanic whites (NHWs). The average wait time reported by Asians was longer than that reported by NHWs. On the basis of EHR data, however, no minority group was likely to wait longer, and all, except for Japanese (10%), were more likely to be late for the appointment (16%: Filipino and 23%: Asian Indian), than NHWs (13%).Given actual wait times, Asians perceive longer wait time and were less satisfied with wait times. Asians may have different expectations about wait time at the clinic.

  View details for DOI 10.1097/MLR.0000000000000473

  View details for PubMedID 26683779

• Dyslipidemia in Special Ethnic Populations ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA Pu, J., Romanelli, R., Zhao, B., Azar, K. M., Hastings, K. G., Nimbal, V., Fortmann, S. P., Palaniappan, L. P. 2016; 45 (1): 205-?

  Abstract

  This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.

  View details for DOI 10.1016/j.ecl.2015.09.013

  View details for Web of Science ID 000373031700014

• Executive Summary: Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., Das, S. R., de Ferranti, S., Després, J., Fullerton, H. J., Howard, V. J., Huffman, M. D., Isasi, C. R., Jiménez, M. C., Judd, S. E., Kissela, B. M., Lichtman, J. H., Lisabeth, L. D., Liu, S., Mackey, R. H., Magid, D. J., McGuire, D. K., Mohler, E. R., Moy, C. S., Muntner, P., Mussolino, M. E., Nasir, K., Neumar, R. W., Nichol, G., Palaniappan, L., Pandey, D. K., Reeves, M. J., Rodriguez, C. J., Rosamond, W., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Woo, D., Yeh, R. W., Turner, M. B. 2016; 133 (4): 447-454

  View details for DOI 10.1161/CIR.0000000000000366

  View details for PubMedID 26811276

• Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., Das, S. R., de Ferranti, S., Després, J., Fullerton, H. J., Howard, V. J., Huffman, M. D., Isasi, C. R., Jiménez, M. C., Judd, S. E., Kissela, B. M., Lichtman, J. H., Lisabeth, L. D., Liu, S., Mackey, R. H., Magid, D. J., McGuire, D. K., Mohler, E. R., Moy, C. S., Muntner, P., Mussolino, M. E., Nasir, K., Neumar, R. W., Nichol, G., Palaniappan, L., Pandey, D. K., Reeves, M. J., Rodriguez, C. J., Rosamond, W., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Woo, D., Yeh, R. W., Turner, M. B. 2016; 133 (4): e38-e360

  View details for DOI 10.1161/CIR.0000000000000350

  View details for PubMedID 26673558

• Improving diet, activity and wellness in adults at risk of diabetes: randomized controlled trial. Nutrition & diabetes Block, G., Azar, K. M., Romanelli, R. J., Block, T. J., Palaniappan, L. P., Dolginsky, M., BLOCK, C. H. 2016; 6 (9)

  Abstract

  The purpose of this analysis is to examine the effect of an algorithm-driven online diabetes prevention program on changes in eating habits, physical activity and wellness/productivity factors.The intervention, Alive-PD, used small-step individually tailored goal setting and other features to promote changes in diet and physical activity. A 6-month randomized controlled trial was conducted among patients from a healthcare delivery system who had confirmed prediabetes (n =339). Change in weight and glycemic markers were measured in the clinic. Changes in physical activity, diet and wellness/productivity factors were self-reported. Mean age was 55 (s.d. 8.9) years, mean body mass index was 31 (s.d. 4.4) kg m(-2), 68% were white and 69% were male.The intervention group increased fruit/vegetable consumption by 3.71 (95% confidence interval (CI) 2.73, 4.70) times per week (effect size 0.62), and decreased refined carbohydrates by 3.77 (95% CI 3.10, 4.44) times per week both significantly (P<0.001) greater changes than in the control group. The intervention group also reported a significantly greater increase in physical activity than in the control group, effect size 0.49, P<0.001. In addition, the intervention group reported a significant increase in self-rated health, in confidence in ability to make dietary changes and in ability to accomplish tasks, and a decrease in fatigue, compared with the control group. These changes paralleled the significant treatment effects on glycemic markers and weight.In addition to promoting improvements in weight and glycemic markers, the Alive-PD program appears to improve eating habits and physical activity, behaviors important not just for diabetes prevention but for those with diagnosed diabetes or obesity. The improvements in wellness/productivity may derive from the diet and activity improvements, and from the satisfaction and self-efficacy of achieving goals.

  View details for DOI 10.1038/nutd.2016.42

  View details for PubMedID 27643726

  View details for PubMedCentralID PMC5048017

• MORTALITY DIFFERENTIALS IN US CHINESE AND JAPANESE NATIVES AND IMMIGRANTS COMPARED TO RESPECTIVE COUNTRIES OF ORIGIN: 2003-2011 Hastings, K., Boothroyd, D., Eggleston, K., Cullen, M., Palaniappan, L. LIPPINCOTT WILLIAMS & WILKINS. 2016: 311

  View details for DOI 10.1136/jim-d-15-00013.404

  View details for Web of Science ID 000368699600413

• Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions. World journal of cardiology Akeroyd, J. M., Chan, W. J., Kamal, A. K., Palaniappan, L., Virani, S. S. 2015; 7 (12): 938-947

  Abstract

  To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease (CVD) medications, among South Asian CVD patients.We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies. After exclusions, 26 studies were selected for full text review. Of these, 17 studies were included in the final review. We abstracted data on several factors including study design, study population, method of assessing adherence and adherence rate.These studies were conducted in India (n = 11), Pakistan (n = 3), Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included, 10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale (MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS, and one study utilized Medication Event Monitoring System caps, with the remainder of the studies utilizing pill count and self-report measures. As expected, studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy, provider education and patient counseling to improve medication adherence.The overall medication adherence rates were low in the region, which suggest a growing need for future interventions to improve adherence.

  View details for DOI 10.4330/wjc.v7.i12.938

  View details for PubMedID 26730300

  View details for PubMedCentralID PMC4691821

• Racial/Ethnic Differences in Gestational Diabetes Prevalence and Contribution of Common Risk Factors PAEDIATRIC AND PERINATAL EPIDEMIOLOGY Pu, J., Zhao, B., Wang, E. J., Nimbal, V., Osmundson, S., Kunz, L., Popat, R. A., Chung, S., Palaniappan, L. P. 2015; 29 (5): 436-443

  Abstract

  The White House, the American Heart Association, the Agency for Healthcare Research and Quality, and the National Heart, Lung and Blood Institute have all recently acknowledged the need to disaggregate Asian American subgroups to better understand this heterogeneous racial group. This study aims to assess racial/ethnic differences in relative contribution of risk factors of gestational diabetes mellitus (GDM) among Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese), Hispanics, non-Hispanic blacks, and non-Hispanic whites.Pregnant women in 2007-2012 were identified through California state birth certificate records and linked to the electronic health records in a large mixed-payer ambulatory care organisation in Northern California (n = 24 195). Relative risk and population attributable fraction (PAF) for specific racial/ethnic groups were calculated to assess the contributions of advanced maternal age, overweight/obesity (Centers for Disease Control and Prevention (CDC) standards and World Health Organization (WHO)/American Diabetes Association (ADA) body mass index cut-offs for Asians), family history of type 2 diabetes, and foreign-born status.GDM was most prevalent among Asian Indians (19.3%). Relative risks were similar across all race/ethnic groups. Advanced maternal age had higher PAFs in non-Hispanic whites (22.5%) and Hispanics (22.7%). Meanwhile family history (Asian Indians 22.6%, Chinese 22.9%) and foreign-borne status (Chinese 40.2%, Filipinos 30.2%) had higher PAFs in Asian subgroups. Overweight/obesity was the most important GDM risk factor for non-Hispanic whites, Hispanics, Asian Indians, and Filipinos when the WHO/ADA cut-off points were applied. Advanced maternal age was the only risk factor studied that was modified by race/ethnicity, with non-Hispanic white and Hispanic women being more adversely affected than other racial/ethnic groups.Overweight/obesity, advanced maternal age, family history of type 2 diabetes, and foreign-borne status are important risk factors for GDM. The relative contributions of these risk factors differ by race/ethnicity, mainly due to differences in population prevalence of these risk factors.

  View details for DOI 10.1111/ppe.12209

  View details for Web of Science ID 000359633400009

  View details for PubMedID 26201385

• Impact of Education on Weight in Newly Diagnosed Type 2 Diabetes: Every Little Bit Helps PLOS ONE Azar, K. M., Chung, S., Wang, E. J., Zhao, B., Linde, R. B., Lederer, J., Palaniappan, L. P. 2015; 10 (6)

  Abstract

  Highly structured, intensive behavioral lifestyle interventions have been shown to be efficacious in research settings for type 2 diabetes management and weight loss. We sought to evaluate the benefit of participation in more limited counseling and/or education among individuals with newly diagnosed type 2 diabetes in more modest real-world clinical settings.Electronic Health Records of newly diagnosed type 2 diabetes patients age 35-74 from a large ambulatory group practice were analyzed (n = 1,314). We examined participation in clinic-based lifestyle counseling/education and subsequent weight loss.Of the total cohort, 599 (45.6%) patients received counseling/education with (26.2%) and without (19.4%) medication, 298(22.7%) patients received a prescription for medication alone, and 417(31.7%) patients were only monitored. On average, those who participated in counseling/education attended 2.5 sessions (approximately 2-3 hours). The average weight loss of patients who received counseling/education alone during the follow-up period (up to three years post-exposure to participation) was 6.3 lbs. (3.3% of body weight), and, if received with medication prescription, 8.1 lbs. (4.0% of body weight) (all at P<0.001). The weight loss associated with medication was only 3.5 lbs. (P<0.001). No significant weight change was observed in the monitoring only group.While efforts to improve both the short-term and long-term effectiveness of behavioral lifestyle interventions in real-world settings are ongoing, it is important for clinicians to continue to utilize less intensive, existing resources. Even relatively small "doses" of health education may help in promoting weight loss and may potentially reduce cardiometabolic risk.

  View details for DOI 10.1371/journal.pone.0129348

  View details for Web of Science ID 000355955300121

  View details for PubMedID 26052698

  View details for PubMedCentralID PMC4459994

• Dyslipidemia in special ethnic populations. Cardiology clinics Pu, J., Romanelli, R., Zhao, B., Azar, K. M., Hastings, K. G., Nimbal, V., Fortmann, S. P., Palaniappan, L. P. 2015; 33 (2): 325-333

  Abstract

  This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.

  View details for DOI 10.1016/j.ccl.2015.01.005

  View details for PubMedID 25939303

  View details for PubMedCentralID PMC4421090

• Dyslipidemia in Special Ethnic Populations CARDIOLOGY CLINICS Pu, J., Romanelli, R., Zhao, B., Azar, K. M., Hastings, K. G., Nimbal, V., Fortmann, S. P., Palaniappan, L. P. 2015; 33 (2): 325-?

  Abstract

  This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.

  View details for DOI 10.1016/j.ccl.2015.01.005

  View details for Web of Science ID 000355774700014

  View details for PubMedID 25939303

  View details for PubMedCentralID PMC4421090

• Racial/Ethnic differences in hypertension prevalence, treatment, and control for outpatients in northern california 2010-2012. American journal of hypertension Zhao, B., Jose, P. O., Pu, J., Chung, S., Ancheta, I. B., Fortmann, S. P., Palaniappan, L. P. 2015; 28 (5): 631-639

  Abstract

  Hypertension (HTN) is a known major cardiovascular disease risk factor, but prevalence, treatment, and control of HTN among rapidly growing minority groups such as Asian Americans and Hispanics are unknown largely due to either underrepresentation in epidemiologic studies or aggregation of Asian American subgroups.A three-year cross-section (2010-2012) of patients from a large ambulatory care setting in northern California was examined in the following subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Mexicans, non-Hispanic Blacks (NHBs), and non-Hispanic Whites (NHWs). We defined HTN as two separate nonemergent office visit blood pressure measurements ≥140/90mm Hg, physician diagnosis of HTN, or use of antihypertensive medications.A total of 208,985 patients were included in the study. Age-adjusted HTN prevalence ranged from 30.0% in Chinese women to 59.9% in Filipino men. Most minority subgroups had lower or similar odds of having HTN compared with NHWs, except for Filipinos and NHBs whose odds were significantly higher after adjusting for patient demographic and clinical characteristics. Asian Americans and NHBs were more likely to be treated for HTN compared with NHWs. Achievement of blood pressure control was lower among Filipino women (odds ratio = 0.82, 99% confidence interval 0.70-0.96) and NHB men (odds ratio = 0.73, 99% confidence interval 0.58-0.91), compared with NHW women and men.Substantial racial/ethnic variation in HTN prevalence, treatment, and control was found in our study population. Filipino and NHB women and men are at especially high risk for HTN and may have more difficulty in achieving adequate blood pressure control.

  View details for DOI 10.1093/ajh/hpu189

  View details for PubMedID 25352230

• Leading Causes of Death among Asian American Subgroups (2003-2011) PLOS ONE Hastings, K. G., Jose, P. O., Kapphahn, K. I., Frank, A. T., Goldstein, B. A., Thompson, C. A., Eggleston, K., Cullen, M. R., Palaniappan, L. P. 2015; 10 (4)

  Abstract

  Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups.We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and non-Hispanic Whites (NHWs) from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%). Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer's disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs.Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.

  View details for DOI 10.1371/journal.pone.0124341

  View details for Web of Science ID 000353659100048

  View details for PubMedID 25915940

  View details for PubMedCentralID PMC4411112

• Comparative effectiveness of early versus delayed metformin in the treatment of type 2 diabetes DIABETES RESEARCH AND CLINICAL PRACTICE Romanelli, R. J., Chung, S., Pu, J., Nimbal, V., Zhao, B., Palaniappan, L. 2015; 108 (1): 170-178

  Abstract

  The purpose of this study was to evaluate the effectiveness of early versus delayed initiation of metformin in type 2 diabetes.We identified 2925 new users of metformin with type 2 diabetes between 2005 and 2012 in the electronic health records of an integrated health system in Northern California. Patients were matched 1:1 on the propensity for receiving early treatment (defined as ≤6 months from first evidence of diabetes). We evaluated the effectiveness of early versus delayed metformin treatment on intermediate clinical outcomes indicated by changes in hemoglobin A1c (HbA1c) and body mass index (BMI), as well as the incidence of therapy intensification (addition or substitution of a second antihyperglycemic agent).A total of 2144 propensity-score matched patients were included in the early or delayed treatment group (n=1072, in each). Early treatment was associated with significantly larger decreases in HbA1c (-0.36%; 95% confidence intervals [CI]: -0.44 to -0.27%; P<0.001) and BMI (-0.46kg/m(2); 95% CI: -0.64 to -0.29kg/m(2); P<0.001) relative to delayed treatment. Patients receiving early treatment also had a greater likelihood of attaining an HbA1c<7% (<53mmol/mol) (odds ratio: 2.00; 95% CI: 1.63-2.45; P<0.001) and a reduced risk of therapy intensification (hazard ratio: 0.72; 95% CI: 0.61-0.85; P<0.001).Treatment with metformin earlier in the course of type 2 diabetes is associated with better glycemic control, more pronounced weight reduction, and a lower risk for therapy intensification than delayed treatment. Antihyperglycemic therapy should be initiated early after diagnosis to achieve optimal outcomes.

  View details for DOI 10.1016/j.diabres.2014.12.019

  View details for Web of Science ID 000352274900031

  View details for PubMedID 25661984

  View details for PubMedCentralID PMC4388779

• Virtual small groups for weight management: an innovative delivery mechanism for evidence-based lifestyle interventions among obese men TRANSLATIONAL BEHAVIORAL MEDICINE Azar, K. M., Aurora, M., Wang, E. J., Muzaffar, A., Pressman, A., Palaniappan, L. P. 2015; 5 (1): 37-44

  Abstract

  While group interventions for weight management have been shown to be efficacious, adherence is often low, especially among men. This pilot study seeks to test whether group interventions using web-based group video conferencing (VC) technology is effective for weight loss. We adapted a 12-week curriculum based on the Diabetes Prevention Program, and delivered this intervention to a small group of men (BMI ≥30 kg/m(2)), using web-based group VC. Participants were randomized to intervention (n = 32) or delayed-intervention control group (n = 32). The intervention group lost 3.5 % (95 % CI 2.1 %, 4.9 %) of their initial body weight. Difference in mean weight loss was 3.2 kg (p = 0.0002) and mean BMI decrease was 1.0 kg/m(2) (p = 0.0010) between the two groups. Virtual small groups may be an effective means of allowing face-to-face group interaction, while overcoming some barriers to access.

  View details for DOI 10.1007/s13142-014-0296-6

  View details for Web of Science ID 000356788400004

  View details for PubMedID 25729451

  View details for PubMedCentralID PMC4332901

• Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting. Primary care diabetes Chung, S., Zhao, B., Lauderdale, D., Linde, R., Stafford, R., Palaniappan, L. 2015; 9 (1): 23-30

  Abstract

  We examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US.Data were extracted from electronic health records (EHR) for active patients ≥35 years in a multispecialty, multiclinic ambulatory care organization with 1000 providers. New onset type 2 diabetes and subsequent treatment were identified using lab, diagnosis, medication prescription, and service use data. Time from the first evidence of diabetes until initial treatment, either medication or education/counseling, was examined using a Kaplan-Meier hazards curve. Potential predictors of initial treatment were examined using multinomial logistic models accounting for physician random effects.Of 2258 patients with incident diabetes, 55% received either medication or education/counseling (20% received both) during the first year. Of the treated patients, 68% received a treatment within the first four weeks, and 13% after initial 16 weeks. Strong positive predictors (P<0.01) of combined treatment were younger age, higher fasting glucose at diagnosis, obesity, and visits with an endocrinologist.Among insured patients who have a primary care provider in a multispecialty health care system, incident diabetes is treated only half the time. Improved algorithms for identifying incident diabetes from the EHR and team approach for monitoring may help treatment initiation.

  View details for DOI 10.1016/j.pcd.2014.04.005

  View details for PubMedID 24810147

  View details for PubMedCentralID PMC4221568

• Initiation of treatment for incident diabetes: Evidence from the electronic health records in an ambulatory care setting. Primary care diabetes Chung, S., Zhao, B., Lauderdale, D., Linde, R., Stafford, R., Palaniappan, L. 2015; 9 (1): 23-30

  View details for DOI 10.1016/j.pcd.2014.04.005

  View details for PubMedID 24810147

• Executive Summary: Heart Disease and Stroke Statistics-2015 Update A Report From the American Heart Association CIRCULATION Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., de Ferranti, S., Despres, J., Fullerton, H. J., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Lackland, D. T., Lichtman, J. H., Lisabeth, L. D., Liu, S., Mackey, R. H., Matchar, D. B., McGuire, D. K., Mohler, E. R., Moy, C. S., Muntner, P., Mussolino, M. E., Nasir, K., Neumar, R. W., Nichol, G., Palaniappan, L., Pandey, D. K., Reeves, M. J., Rodriguez, C. J., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Willey, J. Z., Woo, D., Yeh, R. W., Turner, M. B. 2015; 131 (4): 434-441

  View details for DOI 10.1161/CIR.0000000000000157

  View details for Web of Science ID 000348432100023

• Heart Disease and Stroke Statistics-2015 Update A Report From the American Heart Association CIRCULATION Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., de Ferranti, S., Despres, J., Fullerton, H. J., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Lackland, D. T., Lichtman, J. H., Lisabeth, L. D., Liu, S., Mackey, R. H., Matchar, D. B., McGuire, D. K., Mohler, E. R., Moy, C. S., Muntner, P., Mussolino, M. E., Nasir, K., Neumar, R. W., Nichol, G., Palaniappan, L., Pandey, D. K., Reeves, M. J., Rodriguez, C. J., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Willey, J. Z., Woo, D., Yeh, R. W., Turner, M. B. 2015; 131 (4): E29-E322

  View details for DOI 10.1161/CIR.0000000000000152

  View details for Web of Science ID 000348432100002

  View details for PubMedID 25520374

• Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate. Health affairs Chung, S., Lesser, L. I., Lauderdale, D. S., Johns, N. E., Palaniappan, L. P., Luft, H. S. 2015; 34 (1): 11-20

  Abstract

  Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services.

  View details for DOI 10.1377/hlthaff.2014.0483

  View details for PubMedID 25561639

• Assessment of Obesity and Cardiovascular Risk in South Asians CURRENT CARDIOVASCULAR RISK REPORTS Parikh, N. I., Aurora, M. S., Dash, R., Shin, J. J., Palaniappan, L. 2015; 9 (1)

  View details for DOI 10.1007/s12170-014-0425-2

  View details for Web of Science ID 000420151200004

• MAJOR CAUSES OF DEATH FOR EAST ASIAN SUBGROUPS IN THE UNITED STATES COMPARED TO COUNTRIES OF ORIGIN (2003-2011) Hastings, K. G., Kapphahn, K. I., Hedlin, H., Zhao, B., Cullen, M. R., Barry, M., Palaniappan, L. P., Eggleston, K. KARGER. 2015: 97

  View details for Web of Science ID 000358518200086

• GEOGRAPHIC VARIATION OF CARDIOVASCULAR DISEASE MORTALITY IN ASIAN AMERICAN SUBGROUPS Pu, J., Hastings, K. G., Boothroyd, D., Jose, P. O., Chung, S., Cullen, M. R., Palaniappan, L. P., Rehkopf, D. H. KARGER. 2015: 96

  View details for Web of Science ID 000358518200085

• Diabetes Prevention and Weight Loss with a Fully Automated Behavioral Intervention by Email, Web, and Mobile Phone: A Randomized Controlled Trial Among Persons with Prediabetes. Journal of medical Internet research Block, G., Azar, K. M., Romanelli, R. J., Block, T. J., Hopkins, D., Carpenter, H. A., Dolginsky, M. S., Hudes, M. L., Palaniappan, L. P., Block, C. H. 2015; 17 (10): e240

  Abstract

  One-third of US adults, 86 million people, have prediabetes. Two-thirds of adults are overweight or obese and at risk for diabetes. Effective and affordable interventions are needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed diabetes.The aim was to evaluate the effectiveness of a fully automated algorithm-driven behavioral intervention for diabetes prevention, Alive-PD, delivered via the Web, Internet, mobile phone, and automated phone calls.Alive-PD provided tailored behavioral support for improvements in physical activity, eating habits, and factors such as weight loss, stress, and sleep. Weekly emails suggested small-step goals and linked to an individual Web page with tools for tracking, coaching, social support through virtual teams, competition, and health information. A mobile phone app and automated phone calls provided further support. The trial randomly assigned 339 persons to the Alive-PD intervention (n=163) or a 6-month wait-list usual-care control group (n=176). Participants were eligible if either fasting glucose or glycated hemoglobin A1c (HbA1c) was in the prediabetic range. Primary outcome measures were changes in fasting glucose and HbA1c at 6 months. Secondary outcome measures included clinic-measured changes in body weight, body mass index (BMI), waist circumference, triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio, and Framingham diabetes risk score. Analysis was by intention-to-treat.Participants' mean age was 55 (SD 8.9) years, mean BMI was 31.2 (SD 4.4) kg/m(2), and 68.7% (233/339) were male. Mean fasting glucose was in the prediabetic range (mean 109.9, SD 8.4 mg/dL), whereas the mean HbA1c was 5.6% (SD 0.3), in the normal range. In intention-to-treat analyses, Alive-PD participants achieved significantly greater reductions than controls in fasting glucose (mean -7.36 mg/dL, 95% CI -7.85 to -6.87 vs mean -2.19, 95% CI -2.64 to -1.73, P<.001), HbA1c (mean -0.26%, 95% CI -0.27 to -0.24 vs mean -0.18%, 95% CI -0.19 to -0.16, P<.001), and body weight (mean -3.26 kg, 95% CI -3.26 to -3.25 vs mean -1.26 kg, 95% CI -1.27 to -1.26, P<.001). Reductions in BMI, waist circumference, and TG/HDL were also significantly greater in Alive-PD participants than in the control group. At 6 months, the Alive-PD group reduced their Framingham 8-year diabetes risk from 16% to 11%, significantly more than the control group (P<.001). Participation and retention was good; intervention participants interacted with the program a median of 17 (IQR 14) of 24 weeks and 71.1% (116/163) were still interacting with the program in month 6.Alive-PD improved glycemic control, body weight, BMI, waist circumference, TG/HDL ratio, and diabetes risk. As a fully automated system, the program has high potential for scalability and could potentially reach many of the 86 million US adults who have prediabetes as well as other at-risk groups.Clinicaltrials.gov NCT01479062; https://clinicaltrials.gov/ct2/show/NCT01479062 (Archived by WebCite at http://www.webcitation.org/6bt4V20NR).

  View details for DOI 10.2196/jmir.4897

  View details for PubMedID 26499966

  View details for PubMedCentralID PMC4642405

• AGING & HEALTH Medicare Annual Preventive Care Visits: Use Increased Among Fee-For-Service Patients, But Many Do Not Participate HEALTH AFFAIRS Chung, S., Lesser, L. I., Lauderdale, D. S., Johns, N. E., Palaniappan, L. P., Luft, H. S. 2015; 34 (1): 11-20

  Abstract

  Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services.

  View details for DOI 10.1377/hlthaff.2014.0483

  View details for Web of Science ID 000351716000003

• Engaging South Asian women with type 2 diabetes in a culturally relevant exercise intervention: a randomized controlled trial. BMJ open diabetes research & care Natesan, A., Nimbal, V. C., Ivey, S. L., Wang, E. J., Madsen, K. A., Palaniappan, L. P. 2015; 3 (1)

  Abstract

  We examined the efficacy of a culturally relevant exercise program in improving glycated hemoglobin (HbA1c) among South Asian women with type 2 diabetes, compared with usual care.This was a randomized controlled 8-week pilot study of Bollywood dance among South Asian women with type 2 diabetes. The intervention consisted of 1 h Bollywood dance classes offered twice per week. The primary outcome was change in HbA1c. The effect of attendance on this outcome was also examined.The intervention group demonstrated a decrease in HbA1c from baseline (-0.18% (0.2%); p=0.018) compared with a non-significant increase in the usual care group (+0.03% (0.2%)); p value for difference between groups was 0.032. Participants attending at least 10 of 16 sessions had a statistically significant reduction in weight (-0.69 kg (0.76 kg)) compared with those attending fewer sessions (+0.86 kg (0.71 kg)).These results support culturally relevant dance as a successful exercise intervention to promote HbA1c control, compared with usual care.NCT02061618.

  View details for DOI 10.1136/bmjdrc-2015-000126

  View details for PubMedID 26566446

  View details for PubMedCentralID PMC4636542

• A Fully Automated Diabetes Prevention Program, Alive-PD: Program Design and Randomized Controlled Trial Protocol. JMIR research protocols Block, G., Azar, K. M., Block, T. J., Romanelli, R. J., Carpenter, H., Hopkins, D., Palaniappan, L., Block, C. H. 2015; 4 (1)

  Abstract

  In the United States, 86 million adults have pre-diabetes. Evidence-based interventions that are both cost effective and widely scalable are needed to prevent diabetes.Our goal was to develop a fully automated diabetes prevention program and determine its effectiveness in a randomized controlled trial.Subjects with verified pre-diabetes were recruited to participate in a trial of the effectiveness of Alive-PD, a newly developed, 1-year, fully automated behavior change program delivered by email and Web. The program involves weekly tailored goal-setting, team-based and individual challenges, gamification, and other opportunities for interaction. An accompanying mobile phone app supports goal-setting and activity planning. For the trial, participants were randomized by computer algorithm to start the program immediately or after a 6-month delay. The primary outcome measures are change in HbA1c and fasting glucose from baseline to 6 months. The secondary outcome measures are change in HbA1c, glucose, lipids, body mass index (BMI), weight, waist circumference, and blood pressure at 3, 6, 9, and 12 months. Randomization and delivery of the intervention are independent of clinic staff, who are blinded to treatment assignment. Outcomes will be evaluated for the intention-to-treat and per-protocol populations.A total of 340 subjects with pre-diabetes were randomized to the intervention (n=164) or delayed-entry control group (n=176). Baseline characteristics were as follows: mean age 55 (SD 8.9); mean BMI 31.1 (SD 4.3); male 68.5%; mean fasting glucose 109.9 (SD 8.4) mg/dL; and mean HbA1c 5.6 (SD 0.3)%. Data collection and analysis are in progress. We hypothesize that participants in the intervention group will achieve statistically significant reductions in fasting glucose and HbA1c as compared to the control group at 6 months post baseline.The randomized trial will provide rigorous evidence regarding the efficacy of this Web- and Internet-based program in reducing or preventing progression of glycemic markers and indirectly in preventing progression to diabetes.ClinicalTrials.gov NCT01479062; http://clinicaltrials.gov/show/NCT01479062 (Archived by WebCite at http://www.webcitation.org/6U8ODy1vo).

  View details for DOI 10.2196/resprot.4046

  View details for PubMedID 25608692

  View details for PubMedCentralID PMC4319077

• Leading Causes of Death among Asian American Subgroups (2003-2011). PloS one Hastings, K. G., Jose, P. O., Kapphahn, K. I., Frank, A. T., Goldstein, B. A., Thompson, C. A., Eggleston, K., Cullen, M. R., Palaniappan, L. P. 2015; 10 (4)

  Abstract

  Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups.We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and non-Hispanic Whites (NHWs) from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%). Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer's disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs.Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.

  View details for DOI 10.1371/journal.pone.0124341

  View details for PubMedID 25915940

  View details for PubMedCentralID PMC4411112

• Cardiovascular Disease Mortality in Asian Americans JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Jose, P. O., Frank, A. T., Kapphahn, K. I., Goldstein, B. A., Eggleston, K., Hastings, K. G., Cullen, M. R., Palaniappan, L. P. 2014; 64 (23): 2486-2494

  Abstract

  Asian Americans are a rapidly growing racial/ethnic group in the United States. Our current understanding of Asian-American cardiovascular disease mortality patterns is distorted by the aggregation of distinct subgroups.The purpose of the study was to examine heart disease and stroke mortality rates in Asian-American subgroups to determine racial/ethnic differences in cardiovascular disease mortality within the United States.We examined heart disease and stroke mortality rates for the 6 largest Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) from 2003 to 2010. U.S. death records were used to identify race/ethnicity and cause of death by International Classification of Diseases-10th revision coding. Using both U.S. Census data and death record data, standardized mortality ratios (SMRs), relative SMRs (rSMRs), and proportional mortality ratios were calculated for each sex and ethnic group relative to non-Hispanic whites (NHWs).In this study, 10,442,034 death records were examined. Whereas NHW men and women had the highest overall mortality rates, Asian Indian men and women and Filipino men had greater proportionate mortality burden from ischemic heart disease. The proportionate mortality burden of hypertensive heart disease and cerebrovascular disease, especially hemorrhagic stroke, was higher in every Asian-American subgroup compared with NHWs.The heterogeneity in cardiovascular disease mortality patterns among diverse Asian-American subgroups calls attention to the need for more research to help direct more specific treatment and prevention efforts, in particular with hypertension and stroke, to reduce health disparities for this growing population.

  View details for DOI 10.1016/j.jacc.2014.08.048

  View details for Web of Science ID 000345962400007

  View details for PubMedID 25500233

  View details for PubMedCentralID PMC4274749

• Patient and Provider Characteristics Associated with Colorectal, Breast, and Cervical Cancer Screening among Asian Americans CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Thompson, C. A., Gomez, S. L., Chan, A., Chan, J. K., McClellan, S. R., Chung, S., Olson, C., Nimbal, V., Palaniappan, L. P. 2014; 23 (11): 2208-2217

  Abstract

  Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed to recall-based) rates of cancer screening. In this article, we seek to better understand cancer screening patterns in a population of insured Asian Americans.We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population and compared them with non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider- and patient-level) of screening completion among Asian patients.Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient-physician language discordance for mammography [OR, 0.81; 95% confidence interval (CI), 0.71-0.92] and colorectal cancer screening (OR, 0.79; CI, 0.72-0.87) and positively associated with patient-provider gender concordance for mammography (OR, 1.16; CI, 1.00-1.34) and cervical cancer screening (OR, 1.66; CI, 1.51-1.82). In addition, patient enrollment in online health services increased mammography (OR, 1.32; CI, 1.20-1.46) and cervical cancer screening (OR, 1.31; CI, 1.24-1.37).Language- and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations.This study demonstrates how the use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting.

  View details for DOI 10.1158/1055-9965.EPI-14-0487

  View details for Web of Science ID 000345279600003

  View details for PubMedCentralID PMC4221799

• Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Thompson, C. A., Gomez, S. L., Chan, A., Chan, J. K., McClellan, S. R., Chung, S., Olson, C., Nimbal, V., Palaniappan, L. P. 2014; 23 (11): 2208-17

  Abstract

  Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed to recall-based) rates of cancer screening. In this article, we seek to better understand cancer screening patterns in a population of insured Asian Americans.We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population and compared them with non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider- and patient-level) of screening completion among Asian patients.Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient-physician language discordance for mammography [OR, 0.81; 95% confidence interval (CI), 0.71-0.92] and colorectal cancer screening (OR, 0.79; CI, 0.72-0.87) and positively associated with patient-provider gender concordance for mammography (OR, 1.16; CI, 1.00-1.34) and cervical cancer screening (OR, 1.66; CI, 1.51-1.82). In addition, patient enrollment in online health services increased mammography (OR, 1.32; CI, 1.20-1.46) and cervical cancer screening (OR, 1.31; CI, 1.24-1.37).Language- and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations.This study demonstrates how the use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting.

  View details for DOI 10.1158/1055-9965.EPI-14-0487

  View details for PubMedID 25368396

  View details for PubMedCentralID PMC4221799

• Reconsidering the Age Thresholds for Type II Diabetes Screening in the U.S. AMERICAN JOURNAL OF PREVENTIVE MEDICINE Chung, S., Azar, K. M., Baek, M., Lauderdale, D. S., Palaniappan, L. P. 2014; 47 (4): 375-381

  Abstract

  Type II diabetes and its complications can sometimes be prevented, if identified and treated early. One fifth of diabetics in the U.S. remain undiagnosed. Commonly used screening guidelines are inconsistent.To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening, which is recommended by U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines.Cross-sectional analysis of a nationally representative sample from the National Health and Nutrition Examination Survey, 2007-2010. Number of people needed to screen (NNS) to obtain one positive test result was calculated for different guidelines. Sampling weights were applied to construct national estimates. The 2010 Medicare fee schedule was used for cost estimation. Analysis was conducted in January 2014.NNS, under universal screening, drops sharply at age 35 years, from 80 (30-34-year-olds) to 31 (35-39-year-olds). Opportunistic universal screening of eligible people aged ≥35 years would yield an NNS of 15, translating to $66 per positive test. Among people aged 35-44 years (who are not recommended for universal screening by ADA), most (71%) were overweight or obese and all had at least one other ADA risk factor. Only 34% of individuals aged ≥35 years met USPSTF criteria. Strictly enforcing USPSTF guidelines would have resulted in a majority (61%) of potential positive test cases being missed (5,508,164 cases nationwide).Opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed pre-diabetes or diabetes at relatively low cost.

  View details for DOI 10.1016/j.amepre.2014.05.012

  View details for Web of Science ID 000342386700003

  View details for PubMedCentralID PMC4171212

• Reconsidering the age thresholds for type II diabetes screening in the U.S. American journal of preventive medicine Chung, S., Azar, K. M., Baek, M., Lauderdale, D. S., Palaniappan, L. P. 2014; 47 (4): 375-381

  Abstract

  Type II diabetes and its complications can sometimes be prevented, if identified and treated early. One fifth of diabetics in the U.S. remain undiagnosed. Commonly used screening guidelines are inconsistent.To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening, which is recommended by U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines.Cross-sectional analysis of a nationally representative sample from the National Health and Nutrition Examination Survey, 2007-2010. Number of people needed to screen (NNS) to obtain one positive test result was calculated for different guidelines. Sampling weights were applied to construct national estimates. The 2010 Medicare fee schedule was used for cost estimation. Analysis was conducted in January 2014.NNS, under universal screening, drops sharply at age 35 years, from 80 (30-34-year-olds) to 31 (35-39-year-olds). Opportunistic universal screening of eligible people aged ≥35 years would yield an NNS of 15, translating to $66 per positive test. Among people aged 35-44 years (who are not recommended for universal screening by ADA), most (71%) were overweight or obese and all had at least one other ADA risk factor. Only 34% of individuals aged ≥35 years met USPSTF criteria. Strictly enforcing USPSTF guidelines would have resulted in a majority (61%) of potential positive test cases being missed (5,508,164 cases nationwide).Opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed pre-diabetes or diabetes at relatively low cost.

  View details for DOI 10.1016/j.amepre.2014.05.012

  View details for PubMedID 25131213

• Status of Cardiovascular Disease and Stroke in Hispanics/Latinos in the United States A Science Advisory From the American Heart Association CIRCULATION Rodriguez, C. J., Allison, M., Daviglus, M. L., Isasi, C. R., Keller, C., Leira, E. C., Palaniappan, L., Pina, I. L., Ramirez, S. M., Rodriguez, B., Sims, M. 2014; 130 (7): 593-625

  Abstract

  This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches.Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.

  View details for DOI 10.1161/CIR.0000000000000071

  View details for Web of Science ID 000340681000018

  View details for PubMedID 25098323

• Racial/Ethnic Differences in Dyslipidemia Patterns CIRCULATION Frank, A. T., Zhao, B., Jose, P. O., Azar, K. M., Fortmann, S. P., Palaniappan, L. P. 2014; 129 (5): 570-579

  Abstract

  No studies have comprehensively examined the prevalence of dyslipidemia, a major risk factor for cardiovascular disease, among diverse racial/ethnic minority groups. The primary aim of this study was to identify racial/ethnic differences in dyslipidemia among minorities including Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean or Vietnamese), Mexican Americans, and African Americans compared to Non-Hispanic Whites (NHWs).Using a three-year cross-section (2008-2011), we identified 169,430 active primary care patients (35 years or older) from an outpatient health care organization in Northern California. Age-standardized prevalence rates were calculated for three dyslipidemia subtypes: high TG (fasting lab ≥150 mg/dL), low HDL-C (fasting lab <40 [men] and <50 [women] mg/dL), and high LDL-C (fasting lab ≥130mg/dL or taking LDL-lowering agents). Odds ratios were calculated using multivariable logistic regression, adjusting for patient characteristics (age, measured BMI, smoking). Compared to NHWs, every minority subgroup had increased prevalence of high TGs, except African Americans. Most minority groups had increased prevalence of low HDL-C, except for Japanese and African Americans. The prevalence of high LDL-C was increased among Asian Indians, Filipinos, Japanese, and Vietnamese, compared to NHWs.Minority groups, except for African Americans, were more likely to have high TG/low HDL-C dyslipidemia. Further research is needed to determine how racial/ethnic differences in dyslipidemia affect racial/ethnic differences in cardiovascular disease rates.

  View details for DOI 10.1161/CIRCULATIONAHA.113.005757

  View details for Web of Science ID 000330583300013

  View details for PubMedID 24192801

• The Obesity Paradox in Diabetes CURRENT CARDIOLOGY REPORTS Carnethon, M. R., Rasmussen-Torvik, L. J., Palaniappan, L. 2014; 16 (2)

  Abstract

  Overweight or obese adults have demonstrated a survival advantage compared with leaner adults in several population-based samples. This counterintuitive association has been termed the obesity paradox. Evidence for an obesity paradox among persons with diabetes has been less consistent. In the present review, we identified 18 longitudinal studies conducted in cohort studies, patient registries and clinical trial populations that tested the associations between obesity and survival in patients with diabetes. The majority of these studies reported that mortality was lowest in overweight and obese persons, and that leaner adults had the highest relative total and cardiovascular mortality. Some of these studies observed the patterns most strongly in older (age > 65 years) adults. To date, little research has been conducted to identify mechanisms that could explain elevated mortality in leaner adults with diabetes, or to identify strategies for diabetes management or mitigation of elevated mortality risk.

  View details for DOI 10.1007/s11886-013-0446-3

  View details for Web of Science ID 000345084500003

  View details for PubMedID 24408674

• Heart Disease and Stroke Statistics-2014 Update A Report From the American Heart Association CIRCULATION Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., Dai, S., Ford, E. S., Fox, C. S., Franco, S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Kittner, S. J., Lackland, D. T., Lichtman, J. H., Lisabeth, L. D., Mackey, R. H., Magid, D. J., Marcus, G. M., Marelli, A., Matchar, D. B., McGuire, D. K., Mohler, E. R., Moy, C. S., Mussolino, M. E., Neumar, R. W., Nichol, G., Pandey, D. K., Paynter, N. P., Reeves, M. J., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Wong, N. D., Woo, D., Turner, M. B., Amer Heart Assoc Stat Comm, Stroke Stat Subcomm 2014; 129 (3): E28–E292

  View details for DOI 10.1161/01.cir.0000441139.02102.80

  View details for Web of Science ID 000329880700002

  View details for PubMedID 24352519

  View details for PubMedCentralID PMC5408159

• Prediction of gestational diabetes by first trimester hemoglobin A1c Osmundson, S., Zhao, B., Kunz, L., Wang, E., Palaniappan, L. MOSBY-ELSEVIER. 2014: S173

  View details for DOI 10.1016/j.ajog.2013.10.367

  View details for Web of Science ID 000330322600335

• Mobile Applications for Weight Management Theory-Based Content Analysis AMERICAN JOURNAL OF PREVENTIVE MEDICINE Azar, K. M., Lesser, L. I., Laing, B. Y., Stephens, J., Aurora, M. S., Burke, L. E., Palaniappan, L. P. 2013; 45 (5): 583-589

  Abstract

  The use of smartphone applications (apps) to assist with weight management is increasingly prevalent, but the quality of these apps is not well characterized.The goal of the study was to evaluate diet/nutrition and anthropometric tracking apps based on incorporation of features consistent with theories of behavior change.A comparative, descriptive assessment was conducted of the top-rated free apps in the Health and Fitness category available in the iTunes App Store. Health and Fitness apps (N=200) were evaluated using predetermined inclusion/exclusion criteria and categorized based on commonality in functionality, features, and developer description. Four researchers then evaluated the two most popular apps in each category using two instruments: one based on traditional behavioral theory (score range: 0-100) and the other on the Fogg Behavioral Model (score range: 0-6). Data collection and analysis occurred in November 2012.Eligible apps (n=23) were divided into five categories: (1) diet tracking; (2) healthy cooking; (3) weight/anthropometric tracking; (4) grocery decision making; and (5) restaurant decision making. The mean behavioral theory score was 8.1 (SD=4.2); the mean persuasive technology score was 1.9 (SD=1.7). The top-rated app on both scales was Lose It! by Fitnow Inc.All apps received low overall scores for inclusion of behavioral theory-based strategies.

  View details for DOI 10.1016/j.amepre.2013.07.005

  View details for Web of Science ID 000325910800007

  View details for PubMedID 24139771

• Festival Foods in the Immigrant Diet JOURNAL OF IMMIGRANT AND MINORITY HEALTH Azar, K. M., Chen, E., Holland, A. T., Palaniappan, L. P. 2013; 15 (5): 953-960

  Abstract

  Dietary acculturation for immigrant groups has largely been attributed to the "Westernization" of indigenous diets, as characterized by an increased consumption of unhealthy American foods (i.e., fast foods, hamburgers). However, acculturation and adoption of western dietary habits may not fully explain new dietary patterns among racial/ethnic minority immigrants. The immigrant diet may change in such a way that it elaborates on specific ethnic traditions in addition to the incorporation of Western food habits. In this paper, we explore the role that festival foods, those foods that were once eaten a few times a year and on special occasions, play in the regular diet of immigrants to the US. This paper will focus on the overconsumption of ethnic festival foods, which are often high in carbohydrates, animal protein, sugar and fat, as opposed to Western "junk" food, as an explanation for the increased risk of cardiometabolic disorders among new immigrant groups.

  View details for DOI 10.1007/s10903-012-9705-4

  View details for Web of Science ID 000323757500013

  View details for PubMedID 22968231

  View details for PubMedCentralID PMC3552147

• Gender and ethnic differences in the prevalence of type 2 diabetes among Asian subgroups in California JOURNAL OF DIABETES AND ITS COMPLICATIONS Choi, S. E., Liu, M., Palaniappan, L. P., Wang, E. J., Wong, N. D. 2013; 27 (5): 429-435

  Abstract

  AIMS: To investigate gender and ethnic type 2 diabetes (DM) prevalences among California Asian subgroups versus other ethnic groups and if risk factors explain these differences. METHODS: We identified the prevalence of DM and associated risk factors, stratified by gender, among Chinese, Filipino, South Asian, Japanese, Korean, Vietnamese, Mexican, Other Hispanic, African-American, Caucasian, and Native American adults in a large survey conducted in 2009 (n=46,091, projected n=26.6 million). RESULTS: The highest age-adjusted DM prevalence was seen in Native Americans (32.4%), Filipinos (15.8%), and Japanese (11.8%) among men and in Native Americans (16.0%) and African-Americans (13.3%) among women. Caucasian and Mexican men had higher DM prevalences than women. Age and risk factor-adjusted logistic regression showed DM more likely (relative to Caucasians) among women in Koreans (OR=4.6, p<0.01), Native Americans (OR=3.0, p<0.01), and Other Hispanics (OR 2.9, p<0.01) and among men in Filipinos (OR=7.0, p<0.01), South Asians (OR=4.7, p<0.01), and Native Americans (OR=4.7, p<0.01). No specific risk factors accounted for the gender differences. CONCLUSIONS: Ethnic and gender differences in DM prevalence persist, even after adjusting for lifestyle and other risk factors; prevalence is high among certain Asian American subgroups. Different diabetes prevention approaches may be needed across ethnic/gender groups.

  View details for DOI 10.1016/j.jdiacomp.2013.01.002

  View details for Web of Science ID 000325299700004

  View details for PubMedID 23743139

• Racial/Ethnic differences in the prevalence of proteinuric and nonproteinuric diabetic kidney disease. Diabetes care Bhalla, V., Zhao, B., Azar, K. M., Wang, E. J., Choi, S., Wong, E. C., Fortmann, S. P., Palaniappan, L. P. 2013; 36 (5): 1215-1221

  Abstract

  OBJECTIVE To examine racial/ethnic differences in the prevalence of diabetic kidney disease (DKD), with and without proteinuria, in an outpatient health care organization. RESEARCH DESIGN AND METHODS We examined electronic health records for 15,683 persons of non-Hispanic white (NHW), Asian (Asian Indian, Chinese, and Filipino), Hispanic, and non-Hispanic black (NHB) race/ethnicity with type 2 diabetes and no prior history of kidney disease from 2008 to 2010. We directly standardized age- and sex-adjusted prevalence rates of proteinuric DKD (proteinuria with or without low estimated glomerular filtration rate [eGFR]) or nonproteinuric DKD (low eGFR alone). We calculated sex-specific odds ratios of DKD in racial/ethnic minorities (relative to NHWs) after adjustment for traditional DKD risk factors. RESULTS Racial/ethnic minorities had higher rates of proteinuric DKD than NHWs (24.8-37.9 vs. 24.8%) and lower rates of nonproteinuric DKD (6.3-9.8 vs. 11.7%). On adjusted analyses, Chinese (odds ratio 1.39 for women and 1.56 for men), Filipinos (1.57 for women and 1.85 for men), Hispanics (1.46 for women and 1.34 for men), and NHBs (1.50 for women) exhibited significantly (P < 0.01) higher odds of proteinuric DKD than NHWs. Conversely, Chinese, Hispanic, and NHB women and Hispanic men had significantly lower odds of nonproteinuric DKD than NHWs. CONCLUSIONS We found novel racial/ethnic differences in DKD among patients with type 2 diabetes. Racial/ethnic minorities were more likely to have proteinuric DKD and less likely to have nonproteinuric DKD. Future research should examine diverse DKD-related outcomes by race/ethnicity to inform targeted prevention and treatment efforts and to explore the etiology of these differences.

  View details for DOI 10.2337/dc12-0951

  View details for PubMedID 23238659

• American heart association guide for improving cardiovascular health at the community level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation Pearson, T. A., Palaniappan, L. P., Artinian, N. T., Carnethon, M. R., Criqui, M. H., Daniels, S. R., Fonarow, G. C., Fortmann, S. P., Franklin, B. A., Galloway, J. M., Goff, D. C., Heath, G. W., Frank, A. T., Kris-Etherton, P. M., Labarthe, D. R., Murabito, J. M., Sacco, R. L., Sasson, C., Turner, M. B. 2013; 127 (16): 1730-1753

  View details for DOI 10.1161/CIR.0b013e31828f8a94

  View details for PubMedID 23519758

• DIFFERENCES IN CORONARY HEART DISEASE MORTALITY RATES AMONG ASIAN AMERICAN SUBGROUPS: RESULTS FROM THE CAUSES STUDY (CAUSES OF ASIAN AMERICAN MORTALITY AS UNDERSTOOD BY SOCIO-ECONOMIC STATUS) 62nd Annual Scientific Session of the American-College-of-Cardiology Jose, P., Frank, A., Kapphahn, K., Goldstein, B., Cullen, M., Palaniappan, L. ELSEVIER SCIENCE INC. 2013: E1560–E1560

  View details for Web of Science ID 000316555201665

• Racial/ethnic differences in control of cardiovascular risk factors among type 2 diabetes patients in an insured, ambulatory care population JOURNAL OF DIABETES AND ITS COMPLICATIONS Holland, A. T., Zhao, B., Wong, E. C., Choi, S. E., Wong, N. D., Palaniappan, L. P. 2013; 27 (1): 34-40

  Abstract

  This paper examines differences in cardiovascular disease risk factor control among racial/ethnic minorities (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hispanic/Latino, Black/African Americans) with type 2 diabetes compared to Non-Hispanic Whites with type 2 diabetes in an insured, outpatient setting.A three-year, cross-sectional sample of 15,826 patients with type 2 diabetes was studied between 2008 and 2010. Goal attainment rates for three cardiovascular disease risk factors (HbA1c, BP, LDL) were estimated. Logistic regression was used to determine the association between patient characteristics and control of risk factors.Only one fifth (21.1%) of patients achieved simultaneous goal attainment (HbA1c, BP, LDL). After adjustment for patient characteristics and treatment, Black/African American women and men, and Filipino and Hispanic/Latino men were significantly less likely to simultaneously achieve all three goals, compared to Non-Hispanic Whites. Of the three goals, patients were more likely to achieve HbA1c goals (68.7%) than BP (45.7%) or LDL (58.5%) goals. Racial/ethnic differences were more apparent in risk factors that were under better control (i.e. HbA1c).Cardiovascular risk factor control in type 2 diabetes is suboptimal, even in an insured population. Special attention may be required for specific racial/ethnic/gender groups.

  View details for DOI 10.1016/j.jdiacomp.2012.08.006

  View details for Web of Science ID 000314329100009

  View details for PubMedID 23062328

  View details for PubMedCentralID PMC3587775

• Executive Summary: Heart Disease and Stroke Statistics-2013 Update A Report From the American Heart Association CIRCULATION Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Borden, W. B., Bravata, D. M., Dai, S., Ford, E. S., Fox, C. S., Franco, S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Huffman, M. D., Kissela, B. M., Kittner, S. J., Lackland, D. T., Lichtman, J. H., Lisabeth, L. D., Magid, D., Marcus, G. M., Marelli, A., Matchar, D. B., McGuire, D. K., Mohler, E. R., Moy, C. S., Mussolino, M. E., Nichol, G., Paynter, N. P., Schreiner, P. J., Sorlie, P. D., Stein, J., Turan, T. N., Virani, S. S., Wong, N. D., Woo, D., Turner, M. B., Amer Heart Assoc 2013; 127 (1): 143-152

  View details for DOI 10.1161/CIR.0b013e318282ab8f

  View details for Web of Science ID 000313052900032

  View details for PubMedID 23283859

• Heart Disease and Stroke Statistics-2013 Update A Report From the American Heart Association CIRCULATION Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Borden, W. B., Bravata, D. M., Dai, S., Ford, E. S., Fox, C. S., Franco, S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Huffman, M. D., Kissela, B. M., Kittner, S. J., Lackland, D. T., Lichtman, J. H., Lisabeth, L. D., Magid, D., Marcus, G. M., Marelli, A., Matchar, D. B., McGuire, D. K., Mohler, E. R., Moy, C. S., Mussolino, M. E., Nichol, G., Paynter, N. P., Schreiner, P. J., Sorlie, P. D., Stein, J., Turan, T. N., Virani, S. S., Wong, N. D., Woo, D., Turner, M. B., Amer Heart Assoc, Stroke Stat Subcomm 2013; 127 (1): E6–E245

  View details for DOI 10.1161/CIR.0b013e31828124ad

  View details for Web of Science ID 000313052900003

  View details for PubMedID 23239837

  View details for PubMedCentralID PMC5408511

• Finger millet (Ragi, Eleusine coracana L.): a review of its nutritional properties, processing, and plausible health benefits. Advances in food and nutrition research Shobana, S., Krishnaswamy, K., Sudha, V., Malleshi, N. G., Anjana, R. M., Palaniappan, L., Mohan, V. 2013; 69: 1-39

  Abstract

  Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses on its antiquity, consumption, nutrient composition, processing, and health benefits. Of all the cereals and millets, finger millet has the highest amount of calcium (344mg%) and potassium (408mg%). It has higher dietary fiber, minerals, and sulfur containing amino acids compared to white rice, the current major staple in India. Despite finger millet's rich nutrient profile, recent studies indicate lower consumption of millets in general by urban Indians. Finger millet is processed by milling, malting, fermentation, popping, and decortication. Noodles, vermicilli, pasta, Indian sweet (halwa) mixes, papads, soups, and bakery products from finger millet are also emerging. In vitro and in vivo (animal) studies indicated the blood glucose lowering, cholesterol lowering, antiulcerative, wound healing properties, etc., of finger millet. However, appropriate intervention or randomized clinical trials are lacking on these health effects. Glycemic index (GI) studies on finger millet preparations indicate low to high values, but most of the studies were conducted with outdated methodology. Hence, appropriate GI testing of finger millet preparations and short- and long-term human intervention trials may be helpful to establish evidence-based health benefits.

  View details for DOI 10.1016/B978-0-12-410540-9.00001-6

  View details for PubMedID 23522794

• Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome JOURNAL OF SLEEP RESEARCH Baker, F. C., Sassoon, S. A., Kahan, T., Palaniappan, L., Nicholas, C. L., Trinder, J., Colrain, I. M. 2012; 21 (5): 535-545

  Abstract

  Women with severe premenstrual syndrome report sleep-related complaints in the late-luteal phase, but few studies have characterized sleep disturbances prospectively. This study evaluated sleep quality subjectively and objectively using polysomnographic and quantitative electroencephalographic measures in women with severe premenstrual syndrome. Eighteen women with severe premenstrual syndrome (30.5 ± 7.6 years) and 18 women with minimal symptoms (controls, 29.2 ± 7.3 years) had polysomnographic recordings on one night in each of the follicular and late-luteal phases of the menstrual cycle. Women with premenstrual syndrome reported poorer subjective sleep quality when symptomatic in the late-luteal phase compared with the follicular phase (P < 0.05). However, there were no corresponding changes in objective sleep quality. Women with premenstrual syndrome had more slow-wave sleep and slow-wave activity than controls at both menstrual phases (P < 0.05). They also had higher trait-anxiety, depression, fatigue and perceived stress levels than controls at both phases (P < 0.05) and mood worsened in the late-luteal phase. Both groups showed similar menstrual-phase effects on sleep, with increased spindle frequency activity and shorter rapid eye movement sleep episodes in the late-luteal phase. In women with premenstrual syndrome, a poorer subjective sleep quality correlated with higher anxiety (r = -0.64, P = 0.005) and more perceived nighttime awakenings (r = -0.50, P = 0.03). Our findings show that women with premenstrual syndrome perceive their sleep quality to be poorer in the absence of polysomnographically defined poor sleep. Anxiety has a strong impact on sleep quality ratings, suggesting that better control of mood symptoms in women with severe premenstrual syndrome may lead to better subjective sleep quality.

  View details for DOI 10.1111/j.1365-2869.2012.01007.x

  View details for Web of Science ID 000309402400008

  View details for PubMedID 22417163

  View details for PubMedCentralID PMC3376683

• Problems With the Collection and Interpretation of Asian-American Health Data: Omission, Aggregation, and Extrapolation ANNALS OF EPIDEMIOLOGY Holland, A. T., Palaniappan, L. P. 2012; 22 (6): 397-405

  Abstract

  Asian-American citizens are the fastest growing racial/ethnic group in the United States. Nevertheless, data on Asian American health are scarce, and many health disparities for this population remain unknown. Much of our knowledge of Asian American health has been determined by studies in which investigators have either grouped Asian-American subjects together or examined one subgroup alone (e.g., Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese). National health surveys that collect information on Asian-American race/ethnicity frequently omit this population in research reports. When national health data are reported for Asian-American subjects, it is often reported for the aggregated group. This aggregation may mask differences between Asian-American subgroups. When health data are reported by Asian American subgroup, it is generally reported for one subgroup alone. In the Ni-Hon-San study, investigators examined cardiovascular disease in Japanese men living in Japan (Nippon; Ni), Honolulu, Hawaii (Hon), and San Francisco, CA (San). The findings from this study are often incorrectly extrapolated to other Asian-American subgroups. Recommendations to correct the errors associated with omission, aggregation, and extrapolation include: oversampling of Asian Americans, collection and reporting of race/ethnicity data by Asian-American subgroup, and acknowledgement of significant heterogeneity among Asian American subgroups when interpreting data.

  View details for DOI 10.1016/j.annepidem.2012.04.001

  View details for Web of Science ID 000304846300003

  View details for PubMedID 22625997

• Clinically Identified Postpartum Depression in Asian American Mothers JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING Goyal, D., Wang, E. J., Shen, J., Wong, E. C., Palaniappan, L. P. 2012; 41 (3): 408-416

  Abstract

  To identify the clinical diagnosis rate of postpartum depression (PPD) in Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) compared to non-Hispanic Whites.Cross-sectional study using electronic health records (EHR).A large, outpatient, multiservice clinic in Northern California.A diverse clinical population of non-Hispanic White (N = 4582), Asian Indian (N = 1264), Chinese (N = 1160), Filipino (N = 347), Japanese (N = 124), Korean (N = 183), and Vietnamese (N = 147) mothers.Cases of PPD were identified from EHRs using physician diagnosis codes, medication usage, and age standardized for comparison. The relationship between PPD and other demographic variables (race/ethnicity, maternal age, delivery type, marital status, and infant gender) were examined in a multivariate logistic regression model.The PPD diagnosis rate for all Asian American mothers in aggregate was significantly lower than the diagnosis rate in non-Hispanic White mothers. Moreover, of the six Asian American subgroups, PPD diagnosis rates for Asian Indian, Chinese, and Filipino mothers were significantly lower than non-Hispanic White mothers. In multivariate analyses, race/ethnicity, age, and cesarean were significant predictors of PPD.In this insured population, PPD diagnosis rates were lower among Asian Americans, with variability in rates across the individual Asian American subgroups. It is unclear whether these lower rates are due to underreporting, underdiagnosis, or underutilization of mental health care in this setting.

  View details for DOI 10.1111/j.1552-6909.2012.01352.x

  View details for Web of Science ID 000306476800010

  View details for PubMedID 22536783

• A LARGE-SCALE MULTI ETHNIC STUDY OF A DIRECT MEASURE OF INSULIN SENSITIVITY DEMONSTRATES THAT SOUTH ASIANS ARE THE MOST INSULIN RESISTANT ETHNIC GROUP IN THE US 61st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC)/Conference on ACC-i2 with TCT Divakaruni, M. S., Abbasi, F., Desai, M., Lamendola, C., Palaniappan, L., Reaven, G., Assimes, T. ELSEVIER SCIENCE INC. 2012: E1792–E1792

  View details for Web of Science ID 000302326702003

• Accuracy of Data Entry of Patient Race/Ethnicity/Ancestry and Preferred Spoken Language in an Ambulatory Care Setting HEALTH SERVICES RESEARCH Azar, K. M., Moreno, M. R., Wong, E. C., Shin, J. J., Soto, C., Palaniappan, L. P. 2012; 47 (1): 228-240

  Abstract

  To describe data collection methods and to audit staff data entry of patient self-reported race/ethnicity/ancestry and preferred spoken language (R/E/A/L) information.Large mixed payer outpatient health care organization in Northern California, June 2009.Secondary analysis of an audit planned and executed by the Department of Clinical Services.We analyzed concordance between patient written responses and staff data entry.The data entry accuracy rate across questions was high, ranging from 92 to 97 percent. Inaccuracies were due to human error (62 percent), flaws in system design (2 percent), or some combination of both (35 percent).This study highlights the high accuracy of patient self-reported R/E/A/L data entry and identifies some areas for improvement in staff training and technical system design to facilitate further progress.

  View details for DOI 10.1111/j.1475-6773.2011.01305.x

  View details for Web of Science ID 000299040600014

  View details for PubMedID 22092342

• Underdiagnosis of Hypertension Using Electronic Health Records AMERICAN JOURNAL OF HYPERTENSION Banerjee, D., Chung, S., Wong, E. C., Wang, E. J., Stafford, R. S., Palaniappan, L. P. 2012; 25 (1): 97-102

  Abstract

  Hypertension is highly prevalent and contributes to cardiovascular morbidity and mortality. Appropriate identification of hypertension is fundamental for its management. The rates of appropriate hypertension diagnosis in outpatient settings using an electronic health record (EHR) have not been well studied. We sought to identify prevalent and incident hypertension cases in a large outpatient healthcare system, examine the diagnosis rates of prevalent and incident hypertension, and identify clinical and demographic factors associated with appropriate hypertension diagnosis.We analyzed a 3-year, cross-sectional sample of 251,590 patients aged ≥18 years using patient EHRs. Underlying hypertension was defined as two or more abnormal blood pressure (ABP) readings ≥140/90 mm Hg and/or pharmaceutical treatment. Appropriate hypertension diagnosis was defined by the reporting of ICD-9 codes (401.0-401.9). Factors associated with hypertension diagnosis were assessed through multivariate analyses of patient clinical and demographic characteristics.The prevalence of hypertension was 28.7%, and the diagnosis rate was 62.9%. The incidence of hypertension was 13.3%, with a diagnosis rate of 19.9%. Predictors of diagnosis for prevalent hypertension included older age, Asian, African American, higher body mass index (BMI), and increased number of ABP readings. Predictors for incident hypertension diagnosis were similar. In patients with two or more ABP readings, hypertension diagnosis was associated with significantly higher medication treatment rates (92.6% vs. 15.8%, P < 0.0001).Outpatient EHR diagnosis rates are suboptimal, yet EHR diagnosis of hypertension is strongly associated with treatment. Targeted efforts to improve diagnosis should be a priority.

  View details for DOI 10.1038/ajh.2011.179

  View details for PubMedID 22031453

• "All of Those Things We Don't Eat": A Culture-Centered Approach to Dietary Health Meanings for Asian Indians Living in the United States HEALTH COMMUNICATION Koenig, C. J., Dutta, M. J., Kandula, N., Palaniappan, L. 2012; 27 (8): 818-828

  Abstract

  This article applies a culture-centered approach to analyze the dietary health meanings for Asian Indians living in the United States. The data were collected as part of a health promotion program evaluation designed to help Asian Indians reduce their risk of chronic disease. Community members who used two aspects of the program participated in two focus groups to learn about their health care experiences and to engage them in dialogue about how culture impacts their overall health. Using constructionist grounded theory, we demonstrate that one aspect of culture, the discourses around routine dietary choice, is an important, but underrecognized, aspect of culture that influences community members' experiences with health care. We theorize community members' dietary health meanings operate discursively through a dialectic tension between homogeneity and heterogeneity, situated amid culture, structure, and agency. Participants enacted discursive homogeneity when they affirmed dietary health meanings around diet as an important means through which members of the community maintain a sense of continuity of their identity while differentiating them from others. Participants enacted discursive heterogeneity when they voiced dietary health meanings that differentiated community members from one another due to unique life-course trajectories and other membership affiliations. Through this dialectic, community members manage unique Asian Indian identities and create meanings of health and illness in and through their discourses around routine dietary choice. Through making these discursive health meanings audible, we foreground how community members' agency is discursively enacted and to make understandable how discourses of dietary practice influence the therapeutic alliance between primary care providers and members of a minority community.

  View details for DOI 10.1080/10410236.2011.651708

  View details for Web of Science ID 000307953200009

  View details for PubMedID 22364189

• Spectrum of Cardiovascular Diseases in Asian-American Racial/Ethnic Subgroups ANNALS OF EPIDEMIOLOGY Holland, A. T., Wong, E. C., Lauderdale, D. S., Palaniappan, L. P. 2011; 21 (8): 608-614

  Abstract

  To compare the prevalence of coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD) across Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and non-Hispanic white (NHW) subjects in a mixed-payer, outpatient health care organization in California.Electronic health records from 2007 to 2010 were examined for 94,423 Asian and NHW patients. Age-adjusted prevalence rates of CHD, stroke, and PVD, defined by physician International Classification of Diseases, Version 9, codes, were directly standardized to the NHW population. Age-adjusted odds ratios were calculated by the use of logistic regression for each Asian subgroup, by sex, compared with NHWs.The range of age-adjusted prevalence rates were: CHD (1.7%-5.2%), stroke (0.3%-1.8%), and PVD (0.9%-3.4%). The adjusted odds ratios of CHD were significantly higher for Filipino women (1.66; 95% confidence interval; 1.13-2.43) and men (1.47, 1.05-2.06) and Asian Indian men (1.77, 1.43-2.21), and significantly lower for Chinese women (0.72, 0.55-0.94) and men (0.78, 0.65-0.93), compared with NHWs. The odds of stroke were significantly greater for Filipino women (2.02, 1.22-3.34). The odds of PVD were generally lower for all Asian subgroups.There is considerable heterogeneity across Asian subgroups for prevalent CHD, stroke, and PVD. Future research should disaggregate Asian subgroups and cardiovascular outcomes to inform targeted prevention and treatment efforts.

  View details for DOI 10.1016/j.annepidem.2011.04.004

  View details for Web of Science ID 000292808800007

  View details for PubMedID 21737048

  View details for PubMedCentralID PMC3215504

• Type 2 diabetes: Identifying high risk Asian American subgroups in a clinical population DIABETES RESEARCH AND CLINICAL PRACTICE Wang, E. J., Wong, E. C., Dixit, A. A., Fortmann, S. P., Linde, R. B., Palaniappan, L. P. 2011; 93 (2): 248-254

  Abstract

  We compared the prevalence and treatment of type 2 diabetes across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and Non-Hispanic Whites (NHWs) in a Northern California healthcare system.A three-year, cross-sectional sample of patient electronic health records was accessed to compare diabetes prevalence in 21,816 Asian and 73,728 NHWs aged 35+ years. Diabetes was classified through ICD-9 codes, abnormal laboratory values, or use of oral anti-diabetic medication. Multivariate adjusted prevalence rates for each Asian subgroup, and adjusted odds ratios (OR) relative to NHWs, were compared.Age-adjusted prevalence ranged from 5.8% to 18.2% (women) and 8.1 to 25.3% (men). Age-adjusted ORs of Asian subgroups ranged 1.11-3.94 (women) and 1.14-4.56 (men). The odds of diabetes were significantly higher in Asian Indians (women OR 3.44, men OR 3.54) and Filipinos (women OR 3.94, men OR 4.56), compared to NHWs. Results for Asian Indians and Filipinos were similar with age-and-BMI adjustment. Treatment rates across subgroups were 59.7-82.0% (women) and 62.9-79.4% (men).Heterogeneity exists in the prevalence of diabetes across Asian subgroups, independent of obesity prevalence. Asian Indian and Filipino subgroups had particularly high prevalence of diabetes when compared to NHWs. Future studies should explore these clinically important differences among Asian subgroups.

  View details for DOI 10.1016/j.diabres.2011.05.025

  View details for Web of Science ID 000293825400027

  View details for PubMedID 21665315

  View details for PubMedCentralID PMC3156287

• Incorporation of whole, ancient grains into a modern Asian Indian diet to reduce the burden of chronic disease NUTRITION REVIEWS Dixit, A. A., Azar, K. M., Gardner, C. D., Palaniappan, L. P. 2011; 69 (8): 479-488

  Abstract

  Refined carbohydrates, such as white rice and white flour, are the mainstay of the modern Asian Indian diet, and may contribute to the rising incidence of type 2 diabetes and cardiovascular disease in this population. Prior to the 1950s, whole grains such as amaranth, barley, brown rice, millet, and sorghum were more commonly used in Asian Indian cooking. These grains and other non-Indian grains such as couscous, quinoa, and spelt are nutritionally advantageous and may be culturally acceptable carbohydrate substitutes for Asian Indians. This review focuses on practical recommendations for culturally sensitive carbohydrate modification in a modern Asian Indian diet to reduce type 2 diabetes and cardiovascular disease in this population.

  View details for DOI 10.1111/j.1753-4887.2011.00411.x

  View details for Web of Science ID 000293176900005

  View details for PubMedID 21790614

  View details for PubMedCentralID PMC3146027

• Shared Medical Appointments: Promoting Weight Loss in a Clinical Setting JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE Palaniappan, L. P., Muzaffar, A. L., Wang, E. J., Wong, E. C., Orchard, T. J. 2011; 24 (3): 326-328

  Abstract

  Shared medical appointments (SMAs) are 90-minute group appointments for patients with similar medical complaints. SMAs include components of a traditional office visit but provide further emphasis on health education. The effectiveness of SMAs on weight-loss in an outpatient setting has not been studied.Weight-loss SMAs were offered by one physician at the Palo Alto Medical Foundation. Teaching content included Diabetes Prevention Program materials. This analysis includes patients who attended at least one SMA (n = 74) compared with patients in the same physician's practice who had at least one office visit and a body mass index ≥ 25 kg/m(2) (n = 356).The SMA group had a higher proportion of women than the comparison group (76% vs 64%) and were older (mean, 52.4 years; SD, 13.1 years vs mean, 47.0 years; SD, 13.3 years). SMA patients on average lost 1.0% of their baseline weight. Patients in the comparison group on average gained 0.8% of their baseline weight.SMAs may be a viable option for physicians to promote weight loss in the clinical setting.

  View details for DOI 10.3122/jabfm.2011.03.100220

  View details for Web of Science ID 000290384100016

  View details for PubMedID 21551406

  View details for PubMedCentralID PMC3217311

• Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index INTERNATIONAL JOURNAL OF OBESITY Palaniappan, L. P., Wong, E. C., Shin, J. J., Fortmann, S. P., Lauderdale, D. S. 2011; 35 (3): 393-400

  Abstract

  To examine the relationship between body mass index (BMI) and metabolic syndrome for Asian Americans and non-Hispanic Whites (NHWs), given that existing evidence shows racial/ethnic heterogeneity exists in how BMI predicts metabolic syndrome.Electronic health records of 43,507 primary care patients aged 35 years and older with self-identified race/ethnicity of interest (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese or NHW) were analyzed in a mixed-payer, outpatient-focused health-care organization in the San Francisco Bay Area.Metabolic syndrome prevalence is significantly higher in Asians compared with NHWs for every BMI category. For women at the mean age of 55 and BMI of 25  kg  m(-2), the predicted prevalence of metabolic syndrome is 12% for NHW women compared with 30% for Asians; similarly for men, the predicted prevalence of metabolic syndrome is 22% for NHWs compared with 43% of Asians. Compared with NHW women and men with a BMI of 25  kg  m(-2), comparable prevalence of metabolic syndrome was observed at BMI of 19.6  kg  m(-2) for Asian women and 19.9  kg  m(-2) for Asian men. A similar pattern was observed in disaggregated Asian subgroups.In spite of the lower BMI values and lower prevalence of overweight/obesity than NHWs, Asian Americans have higher rates of metabolic syndrome over the range of BMI. Our results indicate that BMI ranges for defining overweight/obesity in Asian populations should be lower than for NHWs.

  View details for DOI 10.1038/ijo.2010.152

  View details for Web of Science ID 000288486300010

  View details for PubMedID 20680014

  View details for PubMedCentralID PMC2989340

• Racial and Ethnic Variation in Lipoprotein (a) Levels among Asian Indian and Chinese Patients. Journal of lipids Banerjee, D., Wong, E. C., Shin, J., Fortmann, S. P., Palaniappan, L. 2011; 2011: 291954-?

  Abstract

  Background. Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD) in Non-Hispanic Whites (NHW). There are known racial/ethnic differences in Lp(a) levels, and the association of Lp(a) with CVD outcomes has not been examined in Asian Americans in the USA. Objective. We hypothesized that Lp(a) levels would differ in Asian Indians and Chinese Americans when compared to NHW and that the relationship between Lp(a) and CVD outcomes would be different in these Asian racial/ethnic subgroups when compared to NHW. Methods. We studied the outpatient electronic health records of 2022 NHW, 295 Asian Indians, and 151 Chinese adults age ≥18 y in Northern California in whom Lp(a) levels were assessed during routine clinical care from 2001 to 2008, excluding those who had received prescriptions for niacin (14.6%). Nonparametric methods were used to compare median Lp(a) levels. Significance was assessed at the P < .0001 level to account for multiple comparisons. CVD outcomes were defined as ischemic heart disease (IHD) (265 events), stroke (122), or peripheral vascular disease (PVD) (87). We used logistic regression to determine the relationship between Lp(a) and CVD outcomes. Results. Both Asian Indians (36 nmol/L) and NHW (29 nmol/L) had higher median Lp(a) levels than Chinese (22 nmol/L, P ≤ .0001 and P = .0032). When stratified by sex, the differences in median Lp(a) between these groups persisted in the 1761 men (AI v CH: P = .001, NHW v CH: P = .0018) but were not statistically significant in the 1130 women (AI v CH: P = .0402, NHW v CH: P = .0761). Asian Indians (OR = 2.0) and Chinese (OR = 4.8) exhibited a trend towards greater risk of IHD with high Lp(a) levels than NHW (OR = 1.4), but no relationship was statistically significant. Conclusion. Asian Indian and NHW men have higher Lp(a) values than Chinese men, with a trend toward, similar associations in women. High Lp(a) may be more strongly associated with IHD in Asian Indians and Chinese, although we did not have a sufficient number of outcomes to confirm this. Further studies should strive to elucidate the relationship between Lp(a) levels, CVD, and race/ethnicity among Asian subgroups in the USA.

  View details for DOI 10.1155/2011/291954

  View details for PubMedID 21660301

• Population Colorectal Cancer Screening Estimates: Comparing Self-Report to Electronic Health Record Data in California. International journal of cancer prevention Palaniappan, L. P., Maxwell, A. E., Crespi, C. M., Wong, E. C., Shin, J., Wang, E. J. 2011; 4 (1)

  Abstract

  INTRODUCTION: Population-based surveys are used to assess colorectal cancer (CRC) screening rates, but may be subject to self-report biases. Clinical data from electronic health records (EHR) are another data source for assessing screening rates and self-report bias; however, use of EHR data for population research is relatively new. We sought to compare CRC screening rates from a self-report survey, the 2007 California Health Interview Survey (CHIS), to EHR data from Palo Alto Medical Foundation (PAMF), a multi-specialty healthcare organization serving three counties in California. METHODS: Ever- and up-to-date CRC screening rates were compared between CHIS respondents (N=18,748) and PAMF patients (N=26,283). Both samples were limited to English proficient subjects aged 51-75 with health insurance and a physician visit in the past two years. PAMF rates were age-sex standardized to the CHIS population. Analyses were stratified by racial/ethnic group. RESULTS: EHR data included PAMF internally completed tests (84%), and patient-reported externally completed tests which were either confirmed (7%) or unconfirmed (9%) by a physician. When excluding unconfirmed tests, PAMF screening rates were 6-14 percentage points lower than CHIS rates, for both ever- and up-to-date CRC screening among Non-Hispanic White, Black, Hispanic/Latino, Chinese, Filipino and Japanese subjects. When including unconfirmed tests, differences in screening rates between the two data sets were minimal. CONCLUSION: Comparability of CRC screening rates from survey data and clinic-based EHR data depends on whether or not unconfirmed patient-reported tests in EHR are included. This indicates a need for validated methods of calculating CRC screening rates in EHR data.

  View details for PubMedID 21857818

  View details for PubMedCentralID PMC3157148

• Call to Action: Cardiovascular Disease in Asian Americans A Science Advisory From the American Heart Association CIRCULATION Palaniappan, L. P., Araneta, M. R., Assimes, T. L., Barrett-Connor, E. L., Carnethon, M. R., Criqui, M. H., Fung, G. L., Narayan, K. M., Patel, H., Taylor-Piliae, R. E., Wilson, P. W., Wong, N. D. 2010; 122 (12): 1242-1252

  View details for DOI 10.1161/CIR.0b013e3181f22af4

  View details for Web of Science ID 000282042100014

  View details for PubMedID 20733105

• Using Name Lists to Infer Asian Racial/Ethnic Subgroups in the Healthcare Setting MEDICAL CARE Wong, E. C., Palaniappan, L. P., Lauderdale, D. S. 2010; 48 (6): 540-546

  Abstract

  Many clinical data sources used to assess health disparities lack Asian subgroup information, but do include patient names.This project validates Asian surname and given name lists for identifying Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) in clinical records.We used 205,000 electronic medical records from the Palo Alto Medical Foundation, a multipayer, outpatient healthcare organization in Northern California, containing patient self-identified race/ethnicity information.Name lists were used to infer racial/ethnic subgroup for patients with self-identified race/ethnicity data. Using self-identification as the "gold standard," sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of classification by name were calculated. Clinical outcomes (obesity and hypertension) were compared for name-identified versus self-identified racial/ethnic groups.With classification using surname and given name, the overall sensitivities ranged from 0.45 to 0.76 for the 6 racial/ethnic groups when no race data are available, and 0.40 to 0.79 when the broad racial classification of "Asian" is known. Specificities ranged from 0.99 to 1.00. PPV and NPV depended on the prevalence of Asians in the population. The lists performed better for men than women and better for persons aged 65 and older. Clinical outcomes were very similar for name-identified and self-identified racial/ethnic groups.In a clinical setting with a high prevalence of Asian Americans, name-identified and self-identified racial/ethnic groups had similar clinical characteristics. Asian name lists may be a valid substitute for identifying Asian subgroups when self-identification is unavailable.

  View details for DOI 10.1097/MLR.0b013e3181d559e9

  View details for Web of Science ID 000278191900008

  View details for PubMedID 20421828

  View details for PubMedCentralID PMC3249427

• Does the Frequency of Pay-for-Performance Payment Matter?-Experience from a Randomized Trial HEALTH SERVICES RESEARCH Chung, S., Palaniappan, L., Wong, E., Rubin, H., Luft, H. 2010; 45 (2): 553-564

  Abstract

  To examine the effects of incentive payment frequency on quality measures in a physician-specific pay-for-performance (P4P) experiment.A multispecialty physician group practice.In 2007, all primary care physicians (n=179) were randomized into two study arms differing by the frequency of incentive payment, either four quarterly bonus checks or a single year-end bonus (maximum of U.S.$5,000/year for both arms).Data were extracted from electronic health records. Quality measure scores between the two arms over four quarters were compared.There was no difference between the two arms in average quality measure score or in total bonus amount earned.Physicians' responses to a P4P program with a small maximum bonus do not differ by frequency of bonus payment.

  View details for DOI 10.1111/j.1475-6773.2009.01072.x

  View details for Web of Science ID 000275335900012

  View details for PubMedID 20059568

  View details for PubMedCentralID PMC2838160

• Report of a National Heart, Lung, and Blood Institute Workshop: Heterogeneity in Cardiometabolic Risk in Asian Americans in the US Opportunities for Research JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Narayan, K. M., Aviles-Santa, L., Oza-Frank, R., Pandey, M., Curb, J. D., McNeely, M., Araneta, M. R., Palaniappan, L., Rajpathak, S., Barrett-Connor, E. 2010; 55 (10): 966-973

  Abstract

  The Asian and Pacific Islander population (Asian Americans) in the U.S. has increased dramatically in the last few decades. Yet, data on cardiovascular disease (CVD) in this population are scarce. The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health conducted an Expert Workshop to: 1) assess the importance of studying CVD in Asian Americans in the U.S.; and 2) consider strategic options for further investigations of CVD in this population. There is considerable geographical, ethnic, cultural, and genetic diversity within this population. Limited data also suggest striking differences in the risk of CVD, obesity, type 2 diabetes mellitus, and other CVD risk factors across the Asian-American population. The Asian-American population is a new diverse pool with less contemporary genetic and cultural admixture relative to groups that have lived in the U.S. for generations, plus it is diverse in lifestyle including culture, diet, and family structure. This diversity provides a window of opportunity for research on genes and gene-environment interactions and also to investigate how acculturation/assimilation to U.S. lifestyles affects health and CVD risk among relatively homogenous groups of recent immigrants. Given the heterogeneity in body weight, body size, and CVD risk, the Asian-American population in the U.S. offers a unique model to study the interaction and relationships between visceral adiposity and adipose tissue distribution and beta cell function, insulin resistance, and atherosclerosis.

  View details for DOI 10.1016/j.jacc.2009.07.075

  View details for Web of Science ID 000275143200002

  View details for PubMedID 20202512

• Effect of Physician-Specific Pay-for-Performance Incentives in a Large Group Practice AMERICAN JOURNAL OF MANAGED CARE Chung, S., Palaniappan, L. P., Trujillo, L. M., Rubin, H. R., Luft, H. S. 2010; 16 (2): E35-E42

  Abstract

  To assess the effect of a physician-specific pay-for-performance program on quality-of-care measures in a large group practice.In 2007, Palo Alto Medical Clinic, a multispecialty physician group practice, changed from group-focused to physician-specific pay-for-performance incentives. Primary care physicians received incentive payments based on their quarterly assessed performance.We examined 9 reported and incentivized clinical outcome and process measures. Five reported and nonincentivized measures were used for comparison purposes. The quality score of each physician for each measure was the main dependent variable and was calculated as follows: Quality Score = (Patients Meeting Target / Eligible Patients) x 100. Differences in scores between 2006 and 2007 were compared with differences in scores between 2005 and 2006. We also compared the performance of Palo Alto Medical Clinic with that of 2 other affiliated physician groups implementing group-level incentives.Eight of 9 reported and incentivized measures showed significant improvement in 2007 compared with 2006. Three measures showed an improvement trend significantly better than the previous year's trend. A similar improvement trend was observed in 1 related measure that was reported but was nonincentivized. However, the improvement trend of Palo Alto Medical Clinic was not consistently different from that of the other 2 physician groups.Small financial incentives (maximum, $5000/year) based on individual physicians' performance may have led to continued or enhanced improvement in well-established ambulatory care measures. Compared with other quality improvement programs having alternative foci for incentives (eg, increasing support for staff hours), the effect of physician-specific incentives was not evident.

  View details for Web of Science ID 000274590800009

  View details for PubMedID 20148608

• LEADING CAUSES OF MORTALITY OF ASIAN INDIANS IN CALIFORNIA ETHNICITY & DISEASE Palaniappan, L., Mukherjea, A., Holland, A., Ivey, S. L. 2010; 20 (1): 53-57

  Abstract

  Asian Indians had one of the highest population growth rates in California between 1990 and 2000. However, few studies have examined common causes of death in this ethnic group in California. We examined leading causes of mortality in Asian Indians in California and analyzed differences across age and sex.Linear interpolation of 1990 and 2000 US Census data were used to calculate population sizes. California mortality data were examined to determine total number of Asian Indian deaths, and analyzed to determine causes of death across age (25-44, 45-64, > or = 65) and sex subgroups.International Classification of Diseases, 9th and 10th revision codes were used to aggregate causes of mortality into disease categories of cardiovascular diseases, cancers, diabetes, traumas/accidents/suicides, infections, and other conditions.Cardiovascular diseases were the leading cause of death for both sexes. Cancers were the second leading cause of death for both sexes. Diabetes and traumas/accidents/suicides were the next most common cause of mortality for females and males respectively. However, differences were found between age groupings across the sexes.This analysis confirms leading causes of death found in other densely-populated Asian Indian regions. It also sheds light on emerging conditions in this population in California. Although contributors to causes of mortality are discussed, more research is needed to understand the unique biological and socio-cultural determinants of disease in Asian Indians. Translation of this research into intervention strategies will reduce the burden of these diseases in this rapidly-growing population in California and the United States.

  View details for Web of Science ID 000274057600011

  View details for PubMedID 20178183

• Collecting Patient Race/Ethnicity and Primary Language Data in Ambulatory Care Settings: A Case Study in Methodology HEALTH SERVICES RESEARCH Palaniappan, L. P., Wong, E. C., Shin, J. J., Moreno, M. R., Otero-Sabogal, R. 2009; 44 (5): 1750-1761

  Abstract

  To collect patient race/ethnicity and language (r/e/l) in an ambulatory care setting.The Palo Alto Medical Foundation (PAMF), December 2006-May 2008.Three pilot studies: (1) Comparing mail versus telephone versus clinic visit questionnaire distribution; (2) comparing the front desk method (FDM) versus exam room method (ERM) in the clinic visit; and (3) determining resource allocation necessary for data entry.Studies were planned and executed by PAMF's Quality and Planning division.Collecting r/e/l data during clinic visits elicited the highest response rate. The FDM yielded higher response rate than the ERM. One full-time equivalent is initially necessary for data entry.Conducting sequential studies can help guide r/e/l collection in a short time frame.

  View details for DOI 10.1111/j.1475-6773.2009.00992.x

  View details for Web of Science ID 000269494600018

  View details for PubMedID 19555396

  View details for PubMedCentralID PMC2754558

• Examining Racial/Ethnic Differences in Lipoprotein(a) Levels Joint Nutrition, Physical Activity and Metabolism Conference/49th Cardiovascular Disease Epidemiology and Prevention of the American-Heart-Association Banerjee, D., Palaniappan, L., Wong, E., Makielski, T., Shin, J., Fortmann, S. LIPPINCOTT WILLIAMS & WILKINS. 2009: E345–E345

  View details for Web of Science ID 000264243700361

• Asian Americans Have a Greater Prevalence of Metabolic Syndrome Despite Lower Body Mass Index Joint Nutrition, Physical Activity and Metabolism Conference/49th Cardiovascular Disease Epidemiology and Prevention of the American-Heart-Association Palaniappan, L., Wong, E. C., Shin, J., Fortmann, S. P., Lauderdale, D. S. LIPPINCOTT WILLIAMS & WILKINS. 2009: E363–E363

  View details for Web of Science ID 000264243700442

• Ethnic differences in the relationship between adiponectin and insulin sensitivity in south Asian and Caucasian women DIABETES CARE Martin, M., Palaniappan, L. P., Kwan, A. C., Reaven, G. M., Reaven, P. D. 2008; 31 (4): 798-801

  Abstract

  To assess whether lower adiponectin concentrations in South Asian Indians may be responsible for their greater degree of insulin resistance.Insulin-mediated glucose uptake and plasma total and high molecular weight (HMW) adiponectin concentrations were quantified in 52 women of South Asian (SA) and Caucasian (CAU) ancestry and compared.Mean +/- SD total (2,965 +/- 1,278 vs. 4,235 +/- 160 ng/ml) and HMW (1,001 +/- 352 vs. 1,591 +/- 854 ng/ml) adiponectin were lower in SAs than CAUs (P < 0.005). Insulin-resistant CAUs (CAU-IR) had lower total (2,665 +/- 1,040 vs. 5,133 +/- 1,086 ng/ml) and HMW (987 +/- 479 vs. 1,935 +/- 838 ng/ml) adiponectin than insulin-sensitive CAUs (CAU-IS) (P < 0.01), but there were no significant differences between insulin-resistant (SA-IR) and insulin-sensitive (SA-IS) SAs. HMW adiponectin did not differ between SA-IR and CAU-IR, but SA-IS had significantly lower adiponectin concentrations than CAU-IS.Insulin resistance status is not associated with significantly lower levels of adiponectin in these SA women, in contrast to the CAU women.

  View details for DOI 10.2337/dc07-1781

  View details for Web of Science ID 000254591900033

  View details for PubMedID 18202246

• Clinical experience with a relatively low carbohydrate, calorie-restricted diet improves insulin sensitivity and associated metabolic abnormalities in overweight, insulin resistant South Asian Indian women ASIA PACIFIC JOURNAL OF CLINICAL NUTRITION Backes, A. C., Abbasi, F., Lamendola, C., McLaughlin, T. L., Reaven, G., Palaniappan, L. P. 2008; 17 (4): 669-671

  Abstract

  South Asian Indians are at increased risk for cardiovascular disease associated with insulin resistance and a dyslipidemia characterized by high triglyceride and low high-density lipoprotein cholesterol concentrations. The purpose of this study is to determine the effects of a calorie-restricted, relatively low carbohydrate diet on weight loss, insulin sensitivity, and associated cardiovascular disease risk factors in overweight, insulin resistant, but apparently healthy, South Asian Indian women. Twenty-three, overweight, insulin resistant, apparently healthy, South Asian Indian women were advised on a calorie-restricted diet containing 40 percent carbohydrate for 3 months. Change in weight, insulin sensitivity (quantified by the steady state plasma glucose concentration during the insulin suppression test), and associated cardiovascular disease risk factors were measured. Weight fell from 75.5 to 70.5 kg (p<0.001), associated with significant decreases in diastolic blood pressure, plasma concentrations (mg/dL) of steady state plasma glucose (217 to 176, p<0.001), triglycerides (137 to 101, p = 0.003), and glucose (98 to 92, p = 0.005). A calorie-restricted diet, moderately lower in carbohydrate, can lead to weight loss, decreased insulin resistance, and reduction in several cardiovascular disease risk factors in overweight, insulin resistant, apparently healthy, South Asian Indian women.

  View details for Web of Science ID 000262520400020

  View details for PubMedID 19114407

• Lipoprotein abnormalities are associated with insulin resistance in South Asian Indian women METABOLISM-CLINICAL AND EXPERIMENTAL Palaniappan, L. P., Kwan, A. C., Abbasi, F., Lamendola, C., McLaughlin, T. L., Reaven, G. M. 2007; 56 (7): 899-904

  Abstract

  South Asian Indians are at increased risk of coronary heart disease (CHD), possibly related to dyslipidemia characterized by high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations. The importance of differences in insulin resistance as compared to abdominal obesity in the development of this atherogenic lipoprotein profile is not clear, and the current cross-sectional study was initiated to examine this issue. Consequently, we defined the relationship between differences in insulin-mediated glucose uptake (IMGU), abdominal obesity, and various measures of lipoprotein metabolism known to increase CHD risk in 52 apparently healthy women of South Asian Indian ancestry. IMGU was quantified by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test and abdominal obesity was assessed by measurement of waist circumference (WC), and the population was divided into tertiles on the basis of their SSPG results. Results indicated that although there were significant differences in SSPG, TG, and HDL-C values, there were no differences in age, blood pressure, total cholesterol, low-density lipoprotein cholesterol, body mass index, or WC between the highest and lowest tertiles. SSPG concentrations were significantly correlated with both log TG (r = 0.44, P = .001) and HDL-C (r = -0.44, P < .001) concentration, whereas TG and HDL-C concentrations were not significantly related to WC. Furthermore, the relationships between SSPG concentration and TG and HDL-C remained significant when adjusted for age and WC. Finally, a more extensive lipoprotein analysis indicated that the most insulin resistant tertile had higher TG concentrations, lower concentrations of HDL-C and HDL-C subclasses, and smaller and denser low-density lipoprotein particles than the most insulin sensitive tertile, despite the 2 groups not being different in age, BMI, or WC. These results indicate that a highly atherogenic lipoprotein profile seen in South Asian Indian women is significantly associated with insulin resistance independent of differences in WC.

  View details for DOI 10.1016/j.metabol.2007.01.020

  View details for Web of Science ID 000247542300007

  View details for PubMedID 17570249

• Predictors of dyslipidemia associated with insulin resistance in South Asian Indian women Palaniappan, L. P., Kwan, A. C., Abbasi, F., Lamendola, C., McLaughlin, T. L., Reaven, G. M. MARY ANN LIEBERT INC. 2006: 689–90

  View details for Web of Science ID 000240177200048

• Sociocultural factors that affect pregnancy outcomes in two dissimilar immigrant groups in the United States JOURNAL OF PEDIATRICS Madan, A., Palaniappan, L., Urizar, G., Wang, Y., Fortmann, S. P., Gould, J. B. 2006; 148 (3): 341-346

  Abstract

  To compare perinatal risks and outcomes in foreign- and U.S.-born Asian-Indian and Mexican women.We evaluated 6.4 million U.S. vital records for births during 1995-2000 to white, foreign- and U.S.-born Asian-Indian and Mexican women. Risks and outcomes were compared by use of chi2 and logistic regression.With the exception of increased teen pregnancy and tobacco use, the favorable sociodemographic profile and increased rate of adverse outcomes seen in foreign-born Asian Indians persisted in their U.S.-born counterparts. In contrast, foreign-born Mexicans had an adverse sociodemographic profile but a low incidence of low birth weight (LBW), whereas U.S.-born Mexicans had an improved sociodemographic profile and increased LBW, prematurity and neonatal death.Perinatal outcomes deteriorate in U.S.-born Mexican women. In contrast, the paradoxically increased incidence of LBW persists in U.S.-born Asian-Indian women. Further research is needed to identify the social and biologic determinants of perinatal outcome.

  View details for DOI 10.1016/j.peds.2005.11.028

  View details for Web of Science ID 000236718700015

  View details for PubMedID 16615964

• Coronary heart disease mortality for six ethnic groups in California, 1990-2000 ANNALS OF EPIDEMIOLOGY Palaniappan, L., Wang, Y., Fortmann, S. P. 2004; 14 (7): 499-506

  Abstract

  To investigate ethnic variations in coronary heart disease death in California, the authors examined total and CHD-specific mortality among non-Hispanic white (white), Hispanic, non-Hispanic black (black), Chinese, Japanese, and Asian Indian Americans. Deaths were identified in the California Mortality Database and population information was derived from the 1990 and 2000 censuses.Age-standardized death rates per 100,000 population were calculated for ages 25 to 84 years from 1990 to 2000. Proportional mortality ratios (PMRs) for each sex and age group were calculated by dividing the proportion of deaths due to CHD in each ethnic group by the proportion of deaths due to CHD in the total population.Blacks had the highest all-cause age-standardized death rates among men (1614) and women (1014). Blacks had the highest CHD death rates among men (272) and women (190). PMRs for CHD were highest in Asian Indian men (161) and women (144), reflective of the higher percentage of CHD deaths compared with all cause deaths in this group. All sex-ethnic groups showed a decline in all cause and CHD mortality compared with the period between 1985 and 1990, except Asian Indian women, who experienced a 16% increase in all cause mortality and 5% increase in CHD mortality.There is considerable heterogeneity in CHD mortality among ethnic subgroups, and additional research is needed to guide treatment and prevention efforts. Blacks and Asian Indians in California are identified as particularly high risk populations.

  View details for DOI 10.1016/j.annepidem.2003.12.001

  View details for Web of Science ID 000223407900009

  View details for PubMedID 15310526

• Depression and the metabolic syndrome in young adults: Findings from the third national health and nutrition examination survey PSYCHOSOMATIC MEDICINE Kinder, L. S., Carnethon, M. R., Palaniappan, L. P., King, A. C., Fortmann, S. P. 2004; 66 (3): 316-322

  Abstract

  Previous reports have suggested that depression may lead to the development of cardiovascular disease through its association with the metabolic syndrome; however, little is known about the relationship between depression and the metabolic syndrome. The aim of this study was to establish an association between depression and the metabolic syndrome in a nationally representative sample.The Third National Health and Nutrition Examination Survey is a population-based health survey of noninstitutionalized US citizens completed between 1988 and 1994. Three thousand one hundred eighty-six men and 3003 women, age 17 to 39, free of coronary heart disease and diabetes, completed the depression module from the Diagnostic Interview Schedule and a medical examination that provided clinical data needed to establish the presence of the metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults.Women with a history of a major depressive episode were twice as likely to have the metabolic syndrome compared with those with no history of depression. The relationship between depression and metabolic syndrome remained after controlling for age, race, education, smoking, physical inactivity, carbohydrate consumption, and alcohol use. Men with a history of depression were not significantly more likely to have the metabolic syndrome.The prevalence of the metabolic syndrome is elevated among women with a history of depression. It is important to better understand the role depression may play in the effort to reduce the prevalence of the metabolic syndrome and its health consequences.

  View details for DOI 10.1097/01.psy.0000124755.91880.f4

  View details for Web of Science ID 000221548300005

  View details for PubMedID 15184689

• The effects of acculturation on high and low risk immigrant populations Madan, A., Palaniappan, L., Wang, Y., Fortmann, S. P., Gould, J. B. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 376A

  View details for Web of Science ID 000220591102203

• Predictors of the incident metabolic syndrome in adults - The Insulin Resistance Atherosclerosis Study DIABETES CARE Palaniappan, L., Carnethon, M. R., Wang, Y., Hanley, A. J., Fortmann, S. P., Haffner, S. M., Wagenknecht, L. 2004; 27 (3): 788-793

  Abstract

  To prospectively investigate predictors of the incident metabolic syndrome in nondiabetic adults.This analysis included 714 white, black, and Hispanic participants in the Insulin Resistance Atherosclerosis Study (IRAS) who were free of the metabolic syndrome at baseline; 139 of these developed the metabolic syndrome in the subsequent 5 years. We examined measures of glucose (fasting and 2 h), insulin (fasting and 2 h, acute insulin response, insulin sensitivity [Si], and proinsulin), lipids (HDL and triglycerides), blood pressure (systolic and diastolic), waist circumference, and baseline physical activity (total energy expenditure) as predictors of the metabolic syndrome. Logistic regression models were adjusted for age, sex, study site, ethnicity, and impaired glucose tolerance. Signal detection analysis was used to identify the characteristics of the highest risk group.The best predictors of incident metabolic syndrome were waist circumference (odds ratio [OR] 1.7 [1.3-2.0] per 11 cm), HDL cholesterol (0.6 [0.4-0.7] per 15 mg/dl), and proinsulin (1.7 [1.4-2.0] per 3.3 pmol/l). Signal detection analysis identified waist circumference (>89 cm in women, >102 cm in men) as the optimal predictor.These findings suggest that obesity may precede the development of other metabolic syndrome components. Interventions that address obesity and reduce waist circumference may reduce the incidence of the metabolic syndrome in nondiabetic adults.

  View details for Web of Science ID 000189307400025

  View details for PubMedID 14988303

• Risk factors for progression to incident hyperinsulinemia: The Atherosclerosis Risk in Communities Study, 1987-1998 AMERICAN JOURNAL OF EPIDEMIOLOGY Carnethon, M. R., Fortmann, S. P., Palaniappan, L., Duncan, B. B., Schmidt, M. I., Chambless, L. E. 2003; 158 (11): 1058-1067

  Abstract

  Hyperinsulinemia is a marker of insulin resistance, a correlate of the metabolic syndrome, and an established precursor of type 2 diabetes. This US study investigated the role of risk factors associated with hyperinsulinemia in cross-sectional studies in progression to incident hyperinsulinemia. Nondiabetic participants from the Atherosclerosis Risk in Communities Study (n = 9,020) were followed from 1987 to 1998 for the development of hyperinsulinemia (fasting serum insulin > or = 90th percentile, 19.1 micro U/ml). After adjustment for demographic characteristics, all risk factors simultaneously, and baseline insulin value, the risk of progressing to hyperinsulinemia increased per standard deviation increase in baseline uric acid (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.2, 1.4; per 1.4 mg/dl) and waist/hip ratio (OR = 1.4, 95% CI: 1.2, 1.5; per 0.08) and was inversely associated with high density lipoprotein cholesterol (OR = 0.8, 95% CI: 0.7, 0.9; per 0.4 mmol/liter). Starting to smoke (OR = 1.5, 95% CI: 1.2, 2.0) and becoming obese (OR = 2.4, 95% CI: 1.8, 3.1) during the study were also associated with increased risk. The associations were similar across race and gender groups. These data suggest that, in addition to weight gain, hyperuricemia, dyslipidemia, and smoking can be detected prior to development of hyperinsulinemia.

  View details for DOI 10.1093/aje/kwg260

  View details for Web of Science ID 000186896800006

  View details for PubMedID 14630601

• Association between microalbuminuria and the metabolic syndrome: NHANES III AMERICAN JOURNAL OF HYPERTENSION Palaniappan, L., Carnethon, M., Fortmann, S. P. 2003; 16 (11): 952-958

  Abstract

  We investigated whether microalbuminuria was associated with the metabolic syndrome by comparing the strength of the association between microalbuminuria and the syndrome as a whole and its individual components. This investigation included 5659 women and men aged 20 to 80 years from the cross-sectional, nationally representative, Third National Health and Nutrition Examination Survey (NHANES III: 1988-1994). Metabolic syndrome was defined as any three of the following: increased waist circumference, increased triglycerides, decreased HDL cholesterol, increased blood pressure, or high fasting glucose. Microalbuminuria was defined as urinary albumin/creatinine ratio of 30 to 300 mg/g. Microalbuminuria was present in 7.8% of women and 5.0% of men. Log linear analysis revealed a significant association between the metabolic syndrome and microalbuminuria in both genders (women chi(2) = 44.1; men chi(2) = 59.6; P <.0001 for both). Microalbuminuria was more common in both women (odds ratio [OR] = 2.2; 95% confidence interval [CI] 1.44, 3.34) and men (OR = 4.1; 95% CI 2.45, 6.74) with metabolic syndrome compared to those without it; 34% of women and 42% of men with microalbuminuria also had metabolic syndrome. After adjusting for other components of the metabolic syndrome, hypertension demonstrated the strongest association with microalbuminuria in both women (OR = 3.34; 95% CI 2.45, 4.55) and men (OR = 2.51; 95% CI 1.63, 3.86). Microalbuminuria and metabolic syndrome are associated in a large, nationally representative cohort, possibly due to early renal effects of hypertension, and it may be useful to consider microalbuminuria as a component of the metabolic syndrome.

  View details for DOI 10.1016/S0895-7061(03)01009-4

  View details for Web of Science ID 000186098500010

  View details for PubMedID 14573334

• Ethnic differences in coronary heart disease and stroke mortality in California, 1990-2000. Palaniappan, L., Wang, Y., Fortmann, S. P. BLACKWELL PUBLISHING INC. 2003: 184

  View details for Web of Science ID 000182564300709

• Association of dietary protein intake and microalbuminuria in healthy adults: Third National Health and Nutrition Examination Survey AMERICAN JOURNAL OF KIDNEY DISEASES Wrone, E. M., Carnethon, M. R., Palaniappan, L., Fortmann, S. P. 2003; 41 (3): 580-587

  Abstract

  The relationship between dietary protein intake (DPI) and microalbuminuria (MA) is unclear. We investigated whether DPI was associated with urinary albumin level in a population sample of persons with normal kidney function.We addressed this question in adults aged 20 to 80 years from the Third National Health and Nutrition Examination Survey (n = 12,422). DPI was assessed from a 24-hour dietary recall and quantified as percentage of total energy intake. MA is defined as urinary albumin-creatinine ratio 30 mg/g (3 mg/mmol) or greater.In multivariable logistic regression models adjusted for sociodemographic characteristics and coronary heart disease risk factors, DPI was not associated with MA in normotensive or nondiabetic persons. In crude models, odds ratios (ORs) for MA were 1.9 (95% confidence interval, 1.2 to 3.0) in persons with hypertension (n = 3,433) and 2.4 (95% confidence interval, 1.1 to 5.2) in those with diabetes (n = 1,165) in the highest (>19%) versus lowest (<11.7%) quintile of DPI. However, in models adjusted for the concurrent prevalence of diabetes or hypertension, this association attenuated to nonsignificance. Persons in the highest quintile of DPI who had both hypertension and diabetes (n = 634) had a significantly elevated OR for MA (3.3; 95% confidence interval, 1.4 to 7.8) compared with those in the lowest quintile.DPI is not associated with MA in healthy persons or those with isolated hypertension or diabetes. However, in persons with both conditions, high DPI is associated with increased prevalence of MA. These findings suggest the need for further research on weight-loss strategies for high-risk persons.

  View details for DOI 10.1053/ajkd.2003.50119

  View details for Web of Science ID 000181324000008

  View details for PubMedID 12612981

• The metabolic syndrome - Prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994 ARCHIVES OF INTERNAL MEDICINE Park, Y. W., Zhu, S. K., Palaniappan, L., Heshka, S., Carnethon, M. R., Heymsfield, S. B. 2003; 163 (4): 427-436

  Abstract

  The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.Metabolic syndrome-associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey.The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P =.86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.

  View details for Web of Science ID 000181207900005

  View details for PubMedID 12588201

  View details for PubMedCentralID PMC3146257

• Risk functions for prediction of cardiovascular disease in elderly Australians: the Dubbo Study MEDICAL JOURNAL OF AUSTRALIA Simons, L. A., SIMONS, J., Friedlander, Y., McCallum, J., Palaniappan, L. 2003; 178 (3): 113-116

  Abstract

  To evaluate a Framingham risk function for coronary heart disease in an elderly Australian cohort and to derive a risk function for cardiovascular disease (CVD) in elderly Australians.Analysis of data from a prospective cohort study (the Dubbo Study) in a semi-urban town (population, 34 000).2805 men and women 60 years and older living in the community, first assessed in 1988, and a subcohort of 2102 free of CVD at study entry.Incidence of CVD (myocardial infarction, coronary death or stroke) over 5 and 10 years.A Framingham risk function assessing "hard" coronary heart disease (ie, myocardial infarction or coronary death) accurately predicted 10-year incidence in men and women aged 60-79 years who were free of prevalent CVD or diabetes at study entry. In a multiple logistic model, CVD incidence was significantly predicted by age, sex, taking antihypertensive medication, blood pressure, smoking, total cholesterol level and diabetes. For a given age and cholesterol level, CVD risk over 5 years was doubled in the presence of antihypertensive medication or diabetes, increased by 50% with cigarette smoking, and halved in women compared with men.We have derived a simple CVD risk function specifically for elderly Australians that employs risk factors readily accessible to all medical practitioners.

  View details for Web of Science ID 000183668000004

  View details for PubMedID 12558481

  View details for PubMedCentralID PMC3133925

• Comparison of usefulness of systolic, diastolic, and mean blood pressure and pulse pressure as predictors of cardiovascular death in patients >/=60 years of age (The Dubbo Study). American journal of cardiology Palaniappan, L., Simons, L. A., Simons, J., Friedlander, Y., McCallum, J. 2002; 90 (12): 1398-1401

  View details for PubMedID 12480056

• Comparison of usefulness of systolic, diastolic, and mean blood pressure and pulse pressure as predictors of cardiovascular death in patients not greater than or equal to 60 years of age (The Dubbo Study) AMERICAN JOURNAL OF CARDIOLOGY Palaniappan, L., Simons, L. A., SIMONS, J., Friedlander, Y., McCallum, J. 2002; 90 (12): 1398-?

  View details for Web of Science ID 000180004000023

  View details for PubMedCentralID PMC3128467

• Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults - The atherosclerosis risk in communities study: 1987-1998 DIABETES CARE Carnethon, M. R., Palaniappan, L. P., Burchfiel, C. M., Brancati, F. L., Fortmann, S. P. 2002; 25 (8): 1358-1364

  Abstract

  In this study, we tested the hypothesis that fasting serum insulin is higher in nonobese black adults than in white adults and that high fasting insulin predicts type 2 diabetes equally well in both groups.At the baseline examination (1987-1989) of the Atherosclerosis Risk in Communities Study, fasting insulin and BMI were measured in 13,416 black and white men and women without diabetes. Participants were examined at years 3, 6, and 9 for incident diabetes based on fasting glucose and American Diabetes Association criteria.Fasting insulin was 19.7 pmol/l higher among nonobese (BMI <30 kg/m(2)) black women compared with white women (race and obesity interaction term, P < 0.01). There were no differences among men. Among nonobese women, the relative risk for developing diabetes was similar between racial groups: 1.4 (95% CI 1.2-1.5) and 1.3 (1.2-1.4) per 60 pmol/l increase in insulin (P < 0.01) for black and white women, respectively (interaction term, P = 0.6). Findings were similar among men. Adjusting for established risk factors did not attenuate this association.Nonobese black women have higher fasting insulin levels than nonobese white women, and fasting insulin is an equally strong predictor of diabetes in both groups. These results suggest one mechanism to explain the excess incidence of diabetes in nonobese black women but do not explain the excess among black men. Future research should evaluate additional factors: genetic, environmental, or the combination of both, which might explain higher fasting insulin among black women when compared with white women.

  View details for Web of Science ID 000185504100016

  View details for PubMedID 12145235

• Heterogeneity in the relationship between ethnicity, BMI, and fasting insulin DIABETES CARE Palaniappan, L. P., Carnethon, M. R., Fortmann, S. P. 2002; 25 (8): 1351-1357

  Abstract

  To determine whether the association of BMI and fasting insulin is modified by ethnicity.Non-Hispanic black (black), non-Hispanic white (white), and Mexican-American men and women aged 20-80 years from the Third National Health and Nutrition Examination Survey (1988-1994) were included in this study. Linear regression models with an interaction term were used to test whether ethnicity modified the association between BMI and fasting insulin.Fasting insulin was 19, 26, 20, and 19% higher in black women than white women with BMI levels of <22, 22-24, 25-27, and 28-30 kg/m(2), respectively. These differences between black and white women converged at BMI levels >30 kg/m(2). Mexican-American women had fasting insulin levels that were 17, 22, 20, and 16% higher than those of white women at BMI levels of 25-27, 28-30, 31-33, and >34 kg/m(2), respectively, but were not different in individuals with BMI levels <25 kg/m(2). Adjusting for established risk factors did not attenuate these associations in women. Differences in fasting insulin among men were not as apparent.These findings suggest that the effect of obesity on insulin sensitivity is different for Americans in ethnic minorities. In black subjects, fasting insulin is higher at lean weight when compared with white and Mexican-American subjects. In Mexican-American subjects, fasting insulin is higher in overweight individuals when compared with white and black subjects. These findings are more pronounced in women than in men. This result reinforces the importance of designing prevention programs that are tailored to meet the needs of specific populations. Investigation of possible explanations for these differences seems warranted.

  View details for Web of Science ID 000185504100015

  View details for PubMedID 12145234

• Risk factors for the development of hyperinsulinemia: The ARIC study. Carnethon, M. R., Palaniappan, L. P., Chambless, L. E., Duncan, B. B., Schmidt, M. I., Eckfeldt, J. H., Fortmann, S. P. OXFORD UNIV PRESS INC. 2002: s25

  View details for Web of Science ID 000175955500098

• Cardiovascular risk factors in ethnic minority women aged <= 30 years AMERICAN JOURNAL OF CARDIOLOGY Palaniappan, L., Anthony, M. N., Mahesh, C., Elliott, M., Killeen, A., Giacherio, D., Rubenfire, M. 2002; 89 (5): 524-529

  Abstract

  Men and women of African and South Asian ancestry in the United States are increasingly recognized as being at greater risk for coronary heart disease (CHD) than Caucasians of European ancestry. Relatively little data on the genetic and lifestyle risk factors that predispose women to CHD in these ethnic minorities are available. We compared coronary risk factors in a volunteer sample of African-American, Asian Indian American, and Caucasian American women of college age. Life style, dietary, hemodynamic and anthropometric parameters, and laboratory data were sought from 70 subjects in each ethnic group. African-American women were found to have lower triglyceride levels and higher apolipoproten A-1, high-density lipoprotein (HDL), lipoprotein (a) (Lp(a)), fibrinogen, and fasting insulin levels. They also consumed more fat and cholesterol than their peers, had a higher percentage of body fat, body weight, and body mass indexes, and reported less physical activity than Caucasians. Asian Indian American women had higher Lp(a), HDL, and fibrinogen levels than Caucasian American women, and also reported less physical activity. Thus, young African- American and Asian Indian American women have several modifiable risk factors as well as some nontraditional lipid risk factors that warrant consideration for explaining the increased prevalence of CHD in these ethnic groups. The tendency toward peripheral insulin insensitivity and increased body fat in this age group of African-American women suggests diet and exercise may reduce the risk of subsequent CHD.

  View details for Web of Science ID 000174140900007

  View details for PubMedID 11867035

• Analysis of CYP21 coding polymorphisms in three ethnic populations: Further evidence of nonamplifying CYP21 alleles among whites MOLECULAR DIAGNOSIS Ozturk, I. C., Wei, W. L., Palaniappan, L., Rubenfire, M., Killeen, A. A. 2000; 5 (1): 47-52

  Abstract

  Adrenal steroid 21-hydroxylase is essential for the synthesis of both mineralocorticoids and glucocorticoids. The gene for this enzyme, CYP21, contains several frequent coding polymorphisms. Because of its essential function in steroid synthesis, polymorphisms in this enzyme might influence a variety of disease processes. However, before disease-association studies are performed, it is important to understand the frequency of these polymorphisms among normal individuals.Using polymerase chain reaction (PCR) with restriction enzyme digestion or size length polymorphism analysis, we measured the frequencies of the +Leu(10), Arg102Lys, and Ser268Thr polymorphisms in CYP21 in healthy whites, blacks, and Indian Americans. The subjects were all young female college students participating in a study of relative risks for cardiovascular disease in these populations.The frequency of each polymorphism among whites, blacks, and Indian Americans were as follows: +Leu(10), 0.55, 0.96, 0.75; Arg102, 0.63, 0.97, 0.82; and Ser268, 0.92, 0.68, 0.79, respectively. With the exception of the frequencies of the Ser268Thr polymorphism among blacks and Indian Americans, there were significantly different frequencies of each polymorphism among all groups (P<.05). Among whites, the distribution of genotypes for the +Leu(10) and Arg102Lys polymorphisms deviated significantly from expected Hardy-Weinberg values because of an excess of homozygotes.Among the ethnic groups, there are statistically significant differences in the frequencies of these common coding polymorphisms in CYP21 that need to be considered in disease-association studies. Deviation from Hardy-Weinberg distributions might be explained by allelic dropout during PCR, a phenomenon previously reported at this locus.

  View details for Web of Science ID 000087211200013

  View details for PubMedID 10837089